纠正继发性甲状旁腺功能亢进对肾性贫血的影响

Effects of secondary hyperparathyroidism treatment on renal anemia

目的 观察慢性肾衰竭血液透析病人继发性甲状旁腺功能亢进症 (甲旁亢 )经活性维生素D3 治疗后 ,其血红蛋白 (Hb)及红细胞压积 (Hct)的变化。方法 用自身对照的方法 ,观察 2 0例维持性血液透析病人经活性维生素D3治疗纠正继发性甲旁亢前后Hb、Hct、促红细胞生成素 (EPO)用量的变化。结果 2 0例病人经活性维生素D3 治疗后 ,免疫反应性甲状旁腺素 (iPTH)由 (5 32 .5 0± 30 8.31 ) μg/ml下降至 (1 35 .0 0± 80 .6 2 ) μg/ml,Hb由 (90 .4 5± 1 3.4 5 )g/L上升至 (1 0 1 .35± 1 4 .93)g/L ,Hct由 (2 9.4 80± 4 .36 3) %上升至 (32 .5 30± 4 .4 4 1 ) % ,EPO用量由 (5 6 1 2 .5 0± 2 5 6 0 .4 2 )IU/周下降至 (4 6 2 5 .0 0± 2 799.79)IU/周。上述所有变化均有统计学意义。结论 随着继发性甲旁亢的纠正 ,肾性贫血得到改善 ,EPO用量减少 。

Objective To observe effect of correction of secondary hyperparathyroidism by using active vitamin D 3 on rhEPO-resisting renal anemia in hemodialysis patients.Methods 20 patients in hemodialysis with secondary hyperparathyroidism were selected and treated with active vitamin D 3 according to the severities of hyperparathyroidism. The levels of Hb, Hct, iPTH and dosages of rhEPO were tested before and after the active vitamin D 3 therapy. Results With dosing of active vitamin D 3, the iPTH declined from (532.50±308.31) μg/ml to (135.00±80.62) μg/ml, the mean Hb level elevated from (90.45±13.45) g/L to (101.35±14.93) g/L, the mean Hct elevated from (29.480±4.363)% to (32.530±4.441)%,the mean dosage of rhEPO declined from (5 612.50±2 560.42) IU/w to (4 625.00±2 799.79) IU/w. All of the changes were significant.Conclusions Correction of secondary hyperparathyroidism by using active vitamin D 3 might improve renal anemia and decrease the dosage of rhEPO, indicating secondary hyperparathyroidism as an important factor in the treatment of rhEPO on renal anemia.