老年维持性血液透析患者促红细胞生成素低反应的影响因素

Elderly maintenance hemodialysis patients with erythropoietin hormone low response factors

目的通过收集老年维持性血液透析患者的临床资料,分析导致老年血液透析患者促红细胞生成素(EPO)低反应性的相关危险因素,探索其EPO低反应的机制,对老年性血液透析患者肾性贫血的治疗效果进行早期预测。方法共选取我院血液净化中心维持性血液透析患者80例,根据患者使用EPO的剂量,采用四分位法分组(高反应组20例,正常反应组40例,低反应组20例),记录患者临床资料、实验室检查结果。结果 EPO抵抗患者占3.8%(3/80)。与高反应组及正常反应组比较,低反应组体质量较低,差异有统计学意义(63.1±10.0)kg、(61.0±8.2)kg vs(55.2±9.9)kg(P<0.05)。与高反应组比较,低反应组合并血液滤过治疗较少65.0%(13/20)vs25.0%(5/20)(P<0.05)。低反应组红细胞、血红蛋白、血细胞比容降低,丙型肝炎抗体阳性率升高,低反应组EPO剂量升高,EPO品牌、EPO给药途径、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂的使用率差异有统计学意义(P<0.05或<0.01)。结论加强低分子毒素的清除无法改善EPO低反应性,血液透析合并血液滤过治疗可以提高EPO反应性,丙型肝炎抗体水平、EPO品牌、EPO给药途径与EPO反应性有差异,这可能与患者免疫紊乱有关。

Objective Through the collection of clinical data,to analyze related risk factors of low reactivity due to erythropoietin（EPO） in elderly hemodialysis patients,exploring the EPO mechanism of the low response,to provide early prediction for the future elderly treatment of hemodialysis patients with renal anemia.Methods A total of 80 patients selected from the hospital blood purification center maintenance hemodialysis,a quarter of division by grouping patients into high-response group（n=20）,normal response group（n=40） and low-response group（n=20） according to EPO dose,and the clinical data,laboratory tests were recorded.Results EPO resistance occurred in 3.8% of patients（3/80）.Comparison with the high-response group and the normal response group,low-response group showed lower body mass,the difference was statistically significant,respectively（63.1±10.0） kg,（61.0±8.2） kg vs（55.2±9.9） kg（P〈0.05）.Compared with that of high-response group,combined hemofiltration treatment of low-response group was significantly less,65.0%（13/20） vs 25.0%（5/20）（P〈0.05）.In low response group,erythrocytes,hemoglobin,hematocrit decreased,hepatitis C antibody positive rate rose,EPO dose increased,the EPO brand,EPO route of administration,angiotensin-converting enzyme inhibitors/angiotensin Ⅱ by body blockers utilization rate difference were all statistically significant（P〈0.05 or 0.01）.Conclusion Enhancing the clear of the low molecular mass toxins can not improve EPO hyporesponsiveness,residual renal function,but hemodialysis merged blood filtration treatment can improve the reactivity of EPO,hepatitis C antibody levels,EPO brand,EPO administration ways and EPO response differences,which may be related with immune disorders in the patients.