慢性肾脏病甲状旁腺素与贫血的相关性研究

Relationship between serum parathyriod hormone level and renal anemia in patients with chronic kidney dis-ease

目的：探讨慢性肾脏病（ CKD ）甲状旁腺素（ PTH ）与肾性贫血的关系。方法测定126例CKD3～5期患者血PTH、血红蛋白（ Hb）、红细胞比容（ Hct）、尿素氮（ BUN）、肌酐（ Cr）水平及维持性血液透析（MHD）患者42例经重组人促红细胞生成素（rhEPO）、骨化三醇-1．25（OH）2D3治疗3个月后变化。结果CKD3期PTH明显升高，CKD4期、CKD5期升高更显著；血PTH与BUN、Cr呈线性正相关（P＜0．01），与内生肌酐清除率（Ccr）、Hb呈线性负相关（P＜0．01）。 MHD患者经rhEPO、1．25（OH）2D3治疗3个月后，根据Hct变化，治疗有效73．8％，无效26．2％。有效组与无效组比较PTH、Hb、Hct差异均有统计学意义（P＜0．01），且PTH下降，Hb、Hct升高。结论 CKD患者随着肾功能下降，血PTH升高。高PTH血症加重肾性贫血且使EPO疗效差，1．25（OH）2D3能降低高PTH血症，随高PTH血症的纠正，肾性贫血得到改善。

Objective To explore the relationship of serum parathyriod hormone （ PTH） level with renal ane-mia in patients with chronic kidney disease （CKD）.Methods Serum levels of PTH,Hb,Hct,BUN,Cr were observed in 126 patients with CKD at stages 3-5,the changes of 42 patients in maintenance hemodialysis（MHD） with recombi-nant human erythropoietin （rhEPO） and calcitriol-1.25（OH）2D3 treatment for three months were determined. Results The serum PTH level was significantly increased in CKD patients at stage 3 and more in CKD patients at stage 4 and 5.There were positive relationship between blood PTH and BUN ,Cr（P〈0.01）,but a negative relation-ship between PTH and Ccr,Hb（P 〈0.01）.42 patients of MHD treated with rhEPO,1.25（OH）2D3 after three months,according to the changes of HCT ,the effective rate was 73.8% and the ineffective rate was 26.2%.The PTH,Hb,HCT of the effective group had statistically significant differences compared with the ineffective group （ all P〈0.01）.Hb and Hct significantly increased and PTH significantly decreased in the effective group .Conclusion CKD patients had decreased renal function ,elevated blood PTH .High serum PTH might aggravate renal anemia and fail to respond to rhEPO.The high serum PTH corrected by using 1.25（OH）2D3 might improve renal anemia,with high plasma PTH correcting .