高水平血清铁蛋白对血液透析患者促红细胞生成素反应性的影响

THE EFFECTS OF HIGH SERUM FERRITIN LEVELS ON ERYTHROPOIETIN RESPONSIVENESS IN MAINTENANCE HEMODIALYSIS PATIENTS

目的：探讨维持性血液透析（MHD）患者在肾性贫血的治疗中高水平血清铁蛋白（SF）对促红细胞生成素（EPO）反应性的影响.方法：纳入31例已接受重组人EPO和蔗糖铁治疗的MHD伴肾性贫血患者,按SF水平分100 μg/L＜SF＜500 μg/L组（A组）和500 μg/L≤SF＜1 200 μg/L组（B组）.两组均通过调整重组人EPO剂量以使血红蛋白达到最佳水平（110～120 g/L）为目标再治疗12周.以血红蛋白升高值、每周EPO用量、促红素抵抗指数（ERI）评估不同SF水平对EPO生成素反应性的影响.结果：两组基线血红蛋白、每周EPO用量和ERI差异均无统计学意义（均P＞0.05）,治疗12周后B组血红蛋白升高值较高,终末每周EPO用量较少、终末ERI较低,与A组比较差异均有统计学意义（均P ＜0.05）.所有患者终末SF与终末EPO和终末ERI均呈负相关关系（r=-0.366,P＜0.05;r=-0.394,P＜0.05）.结论：静脉补充铁剂维持SF在500～1 200 μg/L较维持在100～500 μg/L可进一步改善MHD患者EPO反应性,减少EPO的需要量.

Objective： To investigate the effect of high serum ferritin（SF）levels on erythropoietin （EPO） responsiveness in anemic maintenance hemodialysis （MHD） patients receiving the treatment about renal anemia. Methods：31 anemic MHD patients who had received treatment of recombinant human EPO and intravenous iron sucrose were divided into Group A （SF 100-500 μg/L） and Group B （SF 500-1 200 μg/L）. The hemoglobin levels of all patients were expected to achieve optimal levels 110-120 g/L by adjusting the EPO dose during a subsequent 12-week therapy. The increased value of hemoglobin, weekly dose of EPO and erythropoietin resistance index（ERI）were used to evaluate the effect of different serum ferritin levels on erythropoietin responsiveness in MHD patients. Results： There was no significant difference in the baseline hemoglobin,weekly dose of EPO and the ERI between the two groups（ P 〉0.05）. The increased value of hemoglobin in group B was significantly higher than that in group A at the end of the study period,and the final weekly dose of EPO and the final value of ERI in group B were significantly lower than that in group A（ P 〈0.05）. In all patients serum ferritin levels were negatively correlated with the final weekly dose of EPO and the final ERI respectively（ r =-0. 366, P 〈0.05 and r ： =-0. 394, P 〈0.05）. Conclusion： Compared to the maintenance dose of intravenous iron agent （100-500 μg/L） ,the maintenance dose of intravenous iron agent（500-1 200 μg/L ）to keep SF levels can better improve EPO response and reduce the requirement of EPO for MHD patients.