维持性血液透析患者微炎症状态对促红细胞生成素疗效的影响

Influence of microinflammation status on erythropoietin therapy for patients under maintenance hemodialysis

目的:探讨在维持性血液透析(maintenance hemodialysis,MHD)患者中微炎症状态对重组人促红细胞生成素(recombinant human erythropoietin,r-HuEPO)治疗肾性贫血的影响。方法:53例患者根据血清超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)的水平分为微炎症组(hs-CRP>3 mg/L,n=30)和非炎症组(hs-CRP≤3 mg/L,n=23),测定血红蛋白(hemoglobin,Hb)、血细胞比容(hematocrit,Hct)、r-HuEPO的用量[U/(kg.week)]与Hct的比值(EPO/Hct)、hs-CRP、血清肌酐(serum creatinine,Scr)、血清铁蛋白(serum ferritin,SF)、转铁蛋白饱和度(transferrin saturation,TS)、血清白蛋白(albumin,Alb)、尿素清除指数(urea remove index,KT/V)和全段甲状旁腺激素(intact parathyroid hormone,iPTH)的水平,采用独立样本t检验比较两组间的差异;以EPO/Hct作为EPO反应性的指标,对影响EPO反应性的指标进行多因素分析。结果:微炎症组hs-CRP升高,非炎症组正常,微炎症组的hs-CRP水平显著高于非炎症组(P<0.01),微炎症组的年龄、EPO/Hct水平显著高于非炎症组(P<0.05);多元相关性分析显示EPO反应性(EPO/Hct)与hs-CRP(r=0.538,P<0.01)、KT/V(r=0.277,P<0.05)呈显著正相关,与Alb(r=–0.605,P<0.01)和Scr(r=–0.291,P<0.05)呈显著负相关;多元逐步回归分析显示,hs-CRP和白蛋白是影响EPO反应性的相关危险因素(R2=0.424,P<0.01)。结论:MHD患者存在微炎症状态,微炎症状态是影响MHD患者r-HuEPO反应性的重要因素。

Objective： To investigate the effect of microinflammation status on recombinant human erythropoietin （r-HuEPO） therapy for patients with renal anemia under maintenance hemodialysis. Methods： Based on the serum high sensitivity C-reactive protein （hs-CRP） level, 53 patients under maintenance hemodialysis were divided into a microinflammation group （hs-CRP〉3 mg/L, n=30） and a non-microinflammation group （hs-CRP≤3 mg/L, n=23）. Hemoglobin （Hb）, hematocrit （Hct）, the ratio of dosage of the r-HuEPO [U/（kg.week）] to Hct （EPO/Hct）, serum hs-CRP, creatinine （Scr）, serum ferritin （SF）, transferrin saturation（TS）, albumin （Alb）, urea remove index （KT/V） and intact parathyroid hormone （iPTH） were measured. Data were analyzed by independent t-test, the EPO/Hct ratio was used as the parameter for the responsiveness to r-HuEPO, the factors affecting the responsiveness to r-HuEPO were analyzed by multiple regression analysis. Results： The level of hs-CRP was significantly increased in the microinflammation group compared with that in the non-microinflammation group （P〈0.01）. The age and EPO/Hct ratio were significantly higher in the microinflammation group than those in the non-microinflammation group （both P〈0.05）. Multiple correlation analysis showed that the EPO/Hct ratio was obviously positivecor correlated with the hs-CRP （r=0.538, P〈0.01） and KT/V （r=0.277, P〈0.05）, and was obviously negativecor correlated with Alb（r=–0.605, P〈0.01） and Scr （r=–0.291, P〈0.05）. Multiple stepwise regression analysis indicated that hs-CRP and Alb were the risk factors for responsiveness to r-HuEPO （R2= 0.424, P〈 0.01）. Conclusion： The microinflammatory status exists in patients under maintenance hemodialysis. High level of hs-CRP is an important factor to cause hyporesponsiveness to r-HuEPO.