尿毒症血液透析患者超敏C反应蛋白及铁参数联合检测的临床意义

Clinical significance of combined detection of hs-CRP and iron parameters for hemodialysis patients

目的探讨检测超敏C反应蛋白(hs-CRP)及铁参数检测在尿毒症血液透析患者肾性贫血治疗过程中的应用价值。方法对尿毒症血液透析患者联合使用促红细胞生成素(EPO)和铁剂治疗肾性贫血,在治疗前检测hs-CRP、Hb、网织红细胞血红蛋白含量(CHr)、低色素红细胞百分比(Hypo%)、转铁蛋白受体(sTfR)、血清铁(SI)、转铁蛋白饱和度(TS)和血清铁蛋白(SF),治疗1个月后复查所有参数。按治疗前hs-CRP水平和本科室所测定的hs-CRP的参考值将患者分为两组:无微炎症的患者(Ⅰ组,hs-CRP≤4.92mg/L)和有微炎症的患者(Ⅱ组,hs-CRP>4.92mg/L),将两组患者治疗前、后各参数的变化作统计学分析,观察微炎症对治疗效果的影响。结果治疗前Ⅰ组患者的SI、TS、SF水平明显低于Ⅱ组(P<0.05)、sTfR明显高于Ⅱ组(P<0.05);治疗后Ⅰ组所有参数浓度的变化幅度均明显高于Ⅱ组(P<0.05)。结论尿毒症血液透析患者体内的微炎症反应可影响EPO及铁剂治疗肾性贫血的疗效。联合检测hs-CRP及铁参数,能较好地指导临床用药,预测EPO及铁剂联合治疗的效果。

Objeclive To investigate the clinical significance of combined detection of hs-CRP and iron parameters for hemodialysis patients with renal anemia. Methods For hemodialysis patients with renal anemia treated with erythropoietin（EPO） and chalybeate,hs-CRP, Hb, reticulocyte hemoglobin（CHr）, the percentage of hypoehromie red blood cells （Hypo%）, transferrin receptor （sTfR）,serum iron （S1）,transferrin saturation （TS） and serum ferritin （SF） were detected before treatment. One month later all parameters were detected again. According to the pre-treatment hs-CRP level and the laboratory reference value for hs-CRP （4.92 mg/L）, the patients recruited were divided into two groups,no-inflammation group（group I ,hs-CRP4.92 mg/L） and mi- cro-inflammation group （II group,hs-CRP〉4. 92 mg/L）, the two sets of parameters before treatment and after treatment were statistically analyzed, and level changes were observed to evaluate the micro-inflammation effect. Results Before treatment, in group I ,SI,TS,SF levels were significantly lower than those in group II （P〈0.05）,sTfR level was significantly higher than group II （P〈0.05） ;after treatment, in group I ,level changes of all parameters were significantly greater than group U （P〈0.05）. Condo- sion Mero-inflammatory response in hemodialysis patients with renal anemia may affects the curative effect of EPO and chalybeate. Combined detection of hs-CRP and iron parameters can better guide clinical medication, and predicts the effects of combined therapy of Epo and chalybeate.