维持性血液透析患者血红蛋白和促红细胞生成素剂量的关系及相关因素分析

Analysis of related factors and the relationship between hemoglobin and the dose of EPO in maintenance hemodialysis patients

目的:观察维持性血液透析患者血红蛋白(HGB)和促红细胞生成素(EPO)剂量的关系及分析其相关因素,为患者肾性贫血提供新的诊疗思路。方法:选择在佛山市禅城区中心医院血液透析中心符合纳入标准的患者141例,收集基本临床资料、各项相关生化指标,计算平均每周EPO剂量。分组方法,第一部分按HGB是否达标,分为HGB达标组(HGB≥110 g/L)和HGB不达标组(HGB<110 g/L);第二部分按EPO是否为常规剂量,分为常规剂量组(常规剂量组)[≤150 IU/(kg·周)]和大剂量组(高剂量组)[>150 IU/(kg·周)]。分别进行相关统计分析。结果:与HGB达标组比较,HGB不达标组EPO剂量、铁蛋白、超敏C-反应蛋白(hs-CRP)均明显增高,差异有统计学意义(分别为t=-2.828,P=0.005;t=-2.541,P=0.012;t=-2.001,P=0.047);与常规剂量组相比,高剂量组HGB、铁蛋白、血清铁、转铁蛋白饱和度、透前二氧化碳浓度(TCO2)均较低,差异有统计学意义(分别为t=-2.648,P=0.009;t=-2.060,P=0.041;t=-5.040,P<0.001;t=-4.402,P<0.001;t=-2.450,P=0.016);而女性、使用中心静脉导管透析和采用静脉补铁的患者人数较多,差异有统计学意义(分别为χ^2=4.749,P=0.029;χ^2=4.042,P=0.045;χ^2=11.372,P=0.001)。Pearson相关分析显示HGB与EPO剂量(r=-0.325,P<0.001)、铁蛋白(r=-0.226,P=0.007)、hs-CRP(r=-0.243,P=0.004)呈负相关,与白蛋白(ALB)(r=0.199,P=0.018)呈正相关。EPO剂量与血清铁(r=-0.401,P<0.001)、转铁蛋白饱和度(r=-0.378,P<0.001)、透析前TCO2(r=-0.195,P=0.021)呈负相关,与hs-CRP(r=0.208,P=0.013)呈正相关。结论:HGB不达标患者使用的EPO剂量更大,EPO剂量与铁代谢状态密切相关,增加铁剂、纠正酸中毒、改善微炎性反应状态或可减少EPO用量。

Objective To observe the relationship between hemoglobin(HGB)and the dose of EPO in maintenance hemodialysis patients,and analyze the related factors,provide new diagnosis and treatment ideas for patients with renal anemia.Method The clinical data and related biochemical parameters of the 141 patients were collected,the weekly average dose of EPO was calculated.For statistical analysis,the first section,the patients were divided into HGB compliance group(hemoglobin≥110 g/L)and HGB failure group(hemoglobin<110 g/L)according to the hemoglobin level;the second section,the patients were divided into the conventional dose group[≤150 IU(kg·w)]and the high-dose group[>150 IU(kg·w)]according to the EPO dose.Results When compared with HGB compliance group,HGB failure group showed higher level of the dose of EPO、ferritin and hypersensitive C reaction protein(t=-2.828,P=0.005;t=-2.541,P=0.012;t=-2.001,P=0.047).When compared with conventional dose group,high-dose group showed significantly lower level of hemoglobin、ferritin、serum iron、transferrin saturation、CO2 concentration before hemodialysis(t=-2.648,P=0.009;t=-2.060,P=0.041;t=-5.040,P<0.001;t=-4.402,P<0.001;t=-2.450,P=0.016),more patients in high-dose group who were female、with CVC、using intravenous iron(χ^2=4.749,P=0.029;χ^2=4.042,P=0.045;χ^2=11.372,P=0.001).Pearson correlation analysis showed that hemoglobin was significantly negatively correlated with the dose of EPO(r=-0.325,P<0.001)、ferritin(r=-0.226,P=0.007)、hypersensitive C reaction protein(r=-0.243,P=0.004),positively correlated with albumin(r=0.199,P=0.018).The dose of EPO was significantly negatively correlated with serum iron(r=-0.401,P<0.001)、transferin saturation(r=-0.378,P<0.001)、CO2 concentration before hemodialysis(r=-0.195,P=0.021),positively correlated with hypersensitive C reaction protein(r=0.208,P=0.013).Conclusion Patients with lower level of hemoglobin need higher dose of EPO,the dose of EPO were closely correlated with ferrum metabolism state,increasing intravenous iron、correcting acidosis and improving the micro-inflammatory state may reduce the dose of EPO.