不同剂量rHuEPO对维持性血液透析患者肾性贫血的改善作用

Research of high and low dose H-rHuEPO on uremic anemia in the maintenance heamodialysis patients

目的：观察大剂量重组人促红细胞生成素（rHuEPO）对维持性血液透析（MHD）患者肾性贫血的改善作用。方法：60例MHD患者随机分为3组：对照组（n=20）：给予益比奥3000IU/次,静脉注射,3次/周。治疗1组（n=20）：益比奥1万IU/周,1次静脉注射。治疗2组（n=20）：益比奥1万IU/周,1次静脉注射,在血红蛋白上升至100g/L以后,改为3000IU/次,静脉注射,1次/周维持。总疗程6月。观察患者对透析的耐受以及血红蛋白（Hb）、红细胞压积（Hct）、血浆蛋白（TP）及血脂、肝、肾功能的改善情况。结果：治疗1组和2组在1个月时Hb、Hct即开始明显上升,1~3月上升幅度明显,4~6月上升减慢;同时患者精神状态明显好转;治疗结束时血浆总蛋白、白蛋白、转铁蛋白浓度均较前增加,肝功、肾功及血脂无显著性变化。但后期治疗1组患者血压有升高趋势。结论：大剂量rHuEPO应用可以快速纠正MHD肾性贫血,但血红蛋白上升至100g/L时建议改为3000 IU/周维持,减少医疗费用的同时可降低副反应。

Objective：To observe the clinical effects of high dose of recombinant human erythropoietin（H-rHuEPO） on the improvement of uremicanemia by intravenous injection once a week in the maintenance heamodialysis（MHD） patients.Methods：Sixty patients aged（63.4±7.5） years who were undergoing MHDwere randomly assigned into control group accepted 3 000IU of rHuEPO through intravenous injection twice or 3 times a week,and to treatment group 1 with intravenous infusion of 10000IU of rHuEPO and to treatment group 2 treated as same as group 1,but 3 000IU of rHuEPO through intravenous injection once a week when Hb100g/L after each hemodialysis,6 months as a course.The tolerance to hemodialysis and side effects were observed,and meanwhile blood routine and biochemical examinations were performed in all patients.Results：After 6-month treatment,no significantly difference was found in the lipometabolism,liver function,kidney function with three groups;But hemoglobin,Hct values,albumin and transferrin were significantly improved in treatment group 1 and 2,especially hemoglobin and Hct were markly increased at 1～3 months than at 4～6 months.But it appeared the prevalence of hypertension at the later stage of treatment.Conclusion：H-rHuEPO is a better way to improve uremic anemia of MHD patients.But when Hb≥100g/L or Hct≥30%,the dosage should be decreased to 3000 IU/w in order to reduce the side effects and medical cost,at same time to improve the compliance of patients.