不同年龄维持性血液透析患者促红素低反应性影响因素的相关性研究

The correlation of factors influencing low reactivity of erythropoietin in maintenance hemodialysis patients of different ages

目的分析不同年龄阶段维持性血液透析患者促红素低反应性的相关影响因素,为综合治疗肾性贫血提供新的诊疗思路。方法回顾性分析53例维持性血液透析(MHD)合并促红素治疗低反应性患者的临床资料。以年龄为分组标准,分为老年组(≥60岁)和非老年组(<60岁),比较2组间临床资料的差异,分析各组年龄与促红素低反应的相关影响因素。结果骨代谢,非老年组血磷及甲状旁腺激素水平高于老年组,差异有统计学意义(P<0.05);非老年组血肌酐水平显著高于老年组(P<0.05);非老年组血清白蛋白水平高于老年组,差异有统计学意义(P<0.05);老年组超敏C反应蛋白及铁蛋白水平显著高于非老年组,差异有统计学意义(P<0.05);25例老年患者血红蛋白水平与血肌酐(r=-0.870)、铁蛋白(r=-0.861)、超敏C反应蛋白(r=-0.834)均呈负相关性,与血清白蛋白呈正相关性(r=0.902);而28例非老年促红素低反应性患者,其血红蛋白水平与血磷(r=-0.948)、甲状旁腺激素(r=-0.939)均呈负相关性(P<0.05)。结论不同年龄维持性血液透析患者促红素低反应性相关影响因素不同,临床上应该按照各年龄段影响因素重点给予针对性的干预,能有效改善肾性贫血的达标率,提高患者生活质量。

Objective To analyze the related factors of low reactivity of erythropoietin in patients with maintenance hemodialysis(MHD)at different ages in order to provide a new way of comprehensive treatment for renal anemia.Methods A retrospective study was used to analyze the clinical data of 53 patients with MHD combined with low responsiveness of erythropoietin.The patients were divided into two groups:the elderly group(>60 years old)and the non-elderly group(<60 years old).The differences of clinical data between the two groups were compared.The correlative factors of low erythropoietin response in different age groups were analyzed.Results Bone metabolism:the levels of serum phosphorus and parathyroid hormonein the non-elderly group were higher than those in the elderly group,which were statistically significant differences(P<0.05).The level of serum creatinine in the non-elderly group was significantly higher than that in the elderly group(P<0.05).The level of serum albumin level in the non-elderly group was higher than that in the elderly group,which were statistically significantly difference(P<0.05).The level of hypersensitive C-reactive protein in the elderly group was significantly higher than that in the non-elderly group.A total of 25 patients enrolled were elderly patients with low erythropoietin reactivity,whose hemoglobin level was negatively correlated with ferritin(r=-0.861)and hypersensitive C-reactive protein(r=-0.834),and positively correlated with serum albumin(r=0.902),which were statistically significant difference(P<0.05).However,the hemoglobin levels of 28 non-elderly patients with low erythropoietin reactivity were negatively correlated with serum creatinine(r=-0.870),serum phosphorus(r=-0.948),and parathyroid hormone(r=-0.939),which were significantly differences(P<0.05).Conclusion There are different factors related to the low reactivity of erythropoietin in patients of MHD at different ages.In clinical practice,we should give targeted intervention according to the influence factors of different ages,which may effectively improve the standard rate of renal anemia and improve the quality of life.