合并α-珠蛋白生成障碍性贫血对维持性血液透析患者使用促红素疗效的影响

Influence of alpha thalassemia incorporated in maintenance hemodialysis patients on the efficacy of erythropoietin

目的:探讨维持性血液透析(MHD)患者合并α-珠蛋白生成障碍性贫血(α-珠贫)对其使用促红素纠正贫血疗效的影响。方法:选择12例合并α-珠贫的MHD患者(α-珠贫组),观察其贫血纠正过程及对促红素的反应,并与无合并α-珠贫的12例MHD患者(对照组)进行比较。结果:α-珠贫组患者开始血液透析时的初始血红蛋白水平明显低于对照组(P<0.01)。12例α-珠贫患者在透析治疗的前3个月每周促红素用量虽由137 IU/kg上升至190 IU/kg,血红蛋白仅上升了22 g/L,在此期间α-珠贫组有7例(58%)患者发生心力衰竭,而对照组仅1例(8%)发生心力衰竭,两组比较差异有统计学意义(P<0.05)。在随后3个月中,α-珠贫组患者每周促红素用量升至(234±34)IU/kg,血红蛋白升至(114±3)g/L,贫血得以纠正。α-珠贫组在贫血纠正时及维持期每周促红素用量明显高于对照组(P<0.01)。α-珠贫组12例患者透析期间平均红细胞体积、平均红细胞血红蛋白含量均无明显变化(P均>0.05)。结论:合并α-珠贫可能加重MHD患者的贫血程度,且使其对常规剂量促红素治疗反应不足,需大剂量促红素才可纠正其贫血,但这并不能改变其小细胞低色素状态。

Objective：To discuss the influence of alpha thalassemia incorporated in maintenance hemodialysis patients on the efficacy of erythropoietin ameliorating their anemia.Methods：Twelve maintenance hemodialysis patients with alpha thalassemia（thalassemic group） were selected in guangzhou general hospital of guangzhou command of PLA in recently three years.The correction of anemia and the response to erythropoietin in thalassemic group were studied and compared with those of the control maintenance hemodialysis patients（control group） who were matched for sex,age,primary disease and body weight without thalassemia.Results：The baseline hemoglobin level of patients in thalassemic group was significantly lower than that in control group[（55±10）g/L vs（67±6）g/L,P〈0.01].In the first three months,the mean hemoglobin level of patients in thalassemic group was increased by only 22 g/L despite the erythropoietin dosage increased from 137 IU/（kg·week）to 190 IU/（kg·week）;and heart failure occurred in seven cases of thalassemic group（58%）,with only one case（8%） in control group（P〈0.01）.In the following three months,with the erythropoietin dosage of patients in thalassemic group up to 234±34 IU/kg/week,the hemoglobin level of them increased to 114±3g/L,and the anemia of them were corrected.The erythropoietin dosage requirement of patients in thalassemic group was significantly higher than that of patients in control group in the anemia correction phase and in the maintenance phase[（249±22） vs（153±10）IU/（kg·week）,P〈0.01;（198±21） vs（129±11） IU/（kg·week）,P〈0.01].There were no change in MCV and MCH of the twelve patients in thalassemic group during the treatment（P〈0.05）.Conclusion：Alpha thalassemia could aggravate the anemia of maintenance hemodialysis patients,and their response to routine dose erythropoietin is poor.A higher dose of erythropoietin is required to correct their anemia,but it can＇t change their MCV and MCH.