血管紧张素转换酶抑制剂对血液透析患者贫血和促红细胞生成素用量的影响

Effect of angiotensin-converting enzyme inhibitors on anemia and erythropoietin requirements in hemodialysis patients

目的观察血管紧张素转换酶抑制剂（ACEI）对维持性血液透析患者贫血和促红细胞生成素（EPO）用量的影响。方法90例维持性血液透析合并高血压和贫血的患者，按随机数字表法分为观察组和对照组，每组45例，观察组使用ACEI降血压治疗，对照组使用钙离子拮抗剂（CCB）降血压治疗。比较两组患者在0、2、4、6、8、10、12个月时的血红蛋白、EPO用量、血清EPO。结果观察组的血红蛋白逐渐下降，6个月及之后与对照组比较差异有统计学意义[6个月：（94．21±9．20）g，L比（105．55±9．16）g／L；12个月：（95．90±6．75）g／L比（105．81±4．45）g／L；P〈0．05]；观察组EPO用量逐渐上升，8个月及之后与对照组比较差异有统计学意义[8个月：（10090．75±1918．35）U，周比（7010．32±1600．15）U，周；12个月：（11586．39±2009．76）U／周比（7068．48±1615．35）U／周，P〈0．05]。在整个研究期间，两组患者的血清EPO水平均保持稳定不变。结论ACEI治疗会加重维持性血液透析患者的贫血和降低EPO的疗效。

Objective To observe the effect of angiotensin-converting enzyme inhibitors （ACEI） on anemia and erythropoietin （EPO） requirements in maintenance hemodialysis patients. Methods Ninety maintenance hemodialysis patients with hypertension and anemia were divided into 2 groups by random digits table, observation group （45 cases, using ACEI as antihypertensive treatment）, control group [45 cases, using calcium channel blocker （CCB） as antihypertensive treatment]. The follow-up period after starting ACEI or CCB therapy was one year. The hemoglobin concentration, serum EPO, EPO requirements were compared after 0, 2, 4, 6, 8, 10, 12 months＇ treatment. Results In response to ACEI, the mean hemoglobin value in observation group decreased progressively, reaching statistical significance after 6 months, and it had significant difference compared with that in control group [6 months： （94.21 ± 9.20） g/L vs. （105.55 ±9.16） g/L,12 months： （95.90 ±6.75） g/L vs. （105.81 ±4.45） g/L,P〈0.05]. The EPO requirements experienced a progressive increase in observation group and reached statistical significance after 8 months, compared with those in control group [ 8 months： （10 090.75 ± 1918.35 ） U/week vs. （7010.32 ± 1600.15 ） U/week, 12 months ： （ 11 586.39± 2009.76 ） U/week vs. （ 7068.48 ± 1615.35 ） U/week, P 〈 0.05 ]. Serum erythropoietin concentration remained stable during the study in two groups. Conclusion ACEI can worsen anemia and reduce the efficacy of EPO in maintenance hemodialysis patients.