促红细胞生成素和血管紧张素转换酶抑制剂对血透患者贫血的影响

Effect of angiotensin converting enzyme inhibitor on erythrocyte of erythropoietin treated hemodialysis patient

目的 :了解促红细胞生成素和血管紧张素转换酶抑制剂对维持性血透 (HD)患者红细胞的影响 ,为临床更合理治疗肾性贫血提供依据。 方法 :78例维持性HD患者随机分成HD组、HD +EPO组、HD +ACEI组和HD+EPO +ACEI组四组 ,分别在治疗前、治疗后 3个月空腹抽血检测血红蛋白 (Hb)、红细胞压积 (Hct)、红细胞ATP酶(Na+ K+ATP酶、Ca2 + ATP酶 )活性、血浆谷光甘肽过氧化物酶 (GSH PX)活力及红细胞脂质过氧化物丙二醛 (MDA)含量。 结果 :与HD组比较 ,HD +EPO组治疗后 ,Hb、Hct、红细胞ATP酶 (Na+ K+ATP酶、Ca2 + ATP酶 )活性和血浆GSH PX活力明显升高 ,差异显著 (P <0 0 1) ;红细胞MDA明显降低 ,差异显著 (P <0 0 1)。HD +ACEI治疗后 ,Hct有所下降 ,存有差异 (P <0 0 5 ) ,而Hb、红细胞ATP酶 (Na+ K+ATP酶、Ca2 + ATP酶 )活性、血浆GSH PX活力、红细胞MDA含量均无明显差异 (P >0 0 5 )。 结论 :CRF维持性HD患者经促红细胞生成素治疗后 ,不仅红细胞数量明显升高 ,而且通过提高红细胞ATP酶活性、血浆谷光甘肽过氧化物酶活力 ,减少红细胞脂质过氧化物含量改善红细胞的形态和功能 ,延长红细胞寿命 ,纠正贫血。而血管紧张素转换酶抑制剂则有减少红细胞数量 ,加重贫血的趋势 ,但其对红细胞的形态和功能影响不大。

Objective:To investigate the effects of angiotension Ⅱ converting enzyme inhibitor on hemoglobin/hematocrit levels and erythrocyte kinases in erythropoietin(EPO)treated hemodialysis patients. Methodology:This study included 78 maintenace hemodialysis patients who received EPO treatment without ACEI(EPO group, n =26),EPO treatment plus ACEI(EPO+ACEI group, n =18),ACEI without EPO treatment(ACEI group, n =22),and neither EPO nor ACEI treatment(Control group, n =12),after a three month run in period during which neither ACEI nor EPO were used,or stopped if ever used before.Hemoglobin level(Hb),hematocrit(Hct),Na + K + ATPase,Ca 2+ ATPase,glutathione peroxidase(GSH PX)and malondialdehyde(MDA)of erythrocyte were observed before and after the three months' observation. Results:After three months' treatment,Hb,Hct,N...were significantly higher and MDA significalty lower in EPO group than in the control group(both P <0 01).Hb and Hct were significantly lower in ACEI group than in the control group ( P <0 01,and P <0 05 respectively),while no significant difference in the activities of Na + K + ATPase,Ca 2+ ATPase,GSH PX and MDA was observed between the ACEI group and the control group ( P >0 05). Conclusion:In maintenance hemodialysis patients,EPO treatment can restore not only the levels of Hb and Hct,but also the activities of Na + K + ATPase,Ca 2+ ATPase,GSH PX and MDA.ACEI might increase the resistance to EPO treatment by aggravating anemia,without any effects on the activities of Na + K + ATPase,Ca 2+ ATPase,GSH PX and MDA of erythrocyte.