超纯透析液对血液透析患者促红素低反应性的影响

The effect of ultrapure dialysate on erythropoietin hypo -responsiveness in maintenance hemodialysis patients

目的 探讨超纯透析液对维持性血液透析患者促红细胞生成素低反应性的影响.方法 选择维持性血液透析患者70例,随机分为普通透析液组（CD组,35例）和超纯透析液组（UPD组,35例）,随访1年后观察两组超敏C反应蛋白（hs-CRP）和促红细胞生成素抵抗指数（Erythropoietin resistance index,ERI）的差异.结果 ①以ERI为因变量进行多元逐步线性回归分析,显示hs-CRP是ERI最为重要的独立影响因素（R2=0.699,p＜0.001）;②随访1年后两组间hs-CRP差异有统计学意义（5.12±2.74 vs 3.77±2.19,P＜0.05）,超纯透析液组ERI有明显改善（11.06±5.27 vs 16.42±7.05,p＜0.01）.结论 ①C-反应蛋白升高是促红细胞生成素抵抗的独立影响因素;②使用超纯透析液可改善患者炎症状态和促红素低反应性.

Objectives To explore the effect of ultrapure dialysate on Erythropoietin （EPO） hypo - responsiveness or EPO resistance in patients on maintenance hemodialysis dialysis （MHD）.Methods 70 patients taking regular hemodialysis were randomly divided into two goups： conventional dialysate group （CD n = 35 ）, ultrapure dialysate group（ UPD n =35）, they all had been on hemodialysis for more than 3 months and on erythropoietin （EPO） ≥100 IU/kg per week for more than 3 months. The dose of EPO was titrated to maintain a target Hct level between 33% and 36%. EPO resistance index （ERI） was calculated as weekly EPO dose per kg of body weight, divided by the Hb concentration （weekly EPO dose/kg weight/g Hb）.Laboratory tests include general examination of blood, biochemistry test of blood, serum ferritin, C reactive protein （CRP）, normalized protein catabolic rate （nPCR） and intact parathyroid hormone （iPTH） were detected on each patieesnts. The relationship between ERI and laboratory factors mentioned above were analysed. And after 12 - month treatment, difference of hs - CRP and ERI were researched between the two groups. Results Multiple stepwise linear regression analysis showed that CRP was the most important independent predictor of EPO hypo - responsiveness （ R2 = 0.699, p〈0.001）. Marked difference of hs -CRP and ERI existed between CD group and UPD group （5.12±2.74 vs 3.77±2.19 p〈0.05 and 16.42±7.05 vs 11. 06±5.27, p〈0.01 respectively）. Conclusions CRP is the most important independent predictor of EPO hypo - responsiveness. Use of UPD should be beneficial to the inflammation status and ERI in longterm hemodialysis patients.