阿法依泊汀对慢性肾衰竭透析前患者左心室肥大的影响  

Effect of Epoetin Alfa on Left Ventricular Hypertrophy in Pre-dialysis Patients

作　　者：袁敏[1] 邹建洲[1] 滕杰[1] 方艺[1] 吉俊[1] 钟一红[1] 丁小强[1] 

机构地区：[1]复旦大学附属中山医院肾内科,上海200032

出　　处：《复旦学报（医学版）》2005年第4期415-418,共4页Fudan University Journal of Medical Sciences

摘　　要：目的评价慢性肾衰竭透析前患者使用阿法依泊汀(epoetinalfa,EPO,促红细胞生成素)对左心室肥大(leftventricularhypertrophy,LVH)的影响。方法120例肾功能不全患者,其中治疗组71例,EPO10000U,每周1次,皮下注射,血红蛋白(Hb)升高至110g/L或红细胞压积(Hct)升至35%后,改为隔周1次;对照组49例,不使用EPO。两组同时补充铁剂和叶酸。观察期为1年,观察期间每个月复查肾功能、血常规、血压和心率,每3个月作1次心动超声图检查。结果治疗组贫血明显得到纠正,Hb(g/L)和Hct(%)分别由78.4±2.1和25.6±1.0升至109.1±2.3和38.4±1.3(P<0.05);对照组Hb(g/L)和Hct(%)分别由80.2±2.3和27.8±2.2降至76.5±1.2和24.4±2.5(P<0.05),两组同期相比有显著差异。对肾功能和血压的影响两组同期相比无显著差异。在观察期末超声心动图显示,治疗组左室舒张末内径(LVEDD)由(53.1±3.7)mm降至(49.5±2.4)mm;左室收缩末内径(LVESD)由(34.9±2.7)mm降至(32.5±2.7)mm;室间隔厚度(IVST)由(11.1±0.9)mm降至(10.3±1.3)mm;左室后壁厚度(LVPWT)由(11.8±1.3)mm降至(10.7±0.7)mm;左房径(LAD)由(40.2±4.1)mm降至(37.7±2.5)mm(P<0.05);而对照组LVH继续加重,LVEDD由(52.1±2.9)mm升至(56.7±3.1)mm;LVESD由(34.5±2.6)mm升至(36.7±3.4)mm;IVST由(10.8±1.2)mm升至(12.6±1.7)mm;LVPWT由(11.5±1.7)mm升至(13.7±1.2)mm;LAD由(39.6±4.1)mm升至(43.2±3.0)mm(P<0.05)。两组同期相比有显著差异(6,12个月)。结论透析前使用EPO能改善左心室肥厚,而且不会加重肾功能损伤。Purpose To evaluate the effect of epoetin alfa (EPO) on left ventricular hypertrophy in pre-dialysis patients. Methods Totally 120 subjects with chronic renal failure were enrolled.Among which 71 patients were treated with EPO,initially 10 000 U once a week and later once every two weeks after hemoglobin≥ 110 g/L or hematocrit ≥35%.The remaining 49 patients who did not received EPO treatment were taken as control group.Folic acid and iron were used orally in both groups.In the observation period of 1 year,renal function,blood routine,blood pressure and heart rate were measured every month,echocardiography every 3 months. Results Obvious correction of anemia was found in the treatment group with administration of EPO,hemoglobin (g/L) and hematocrit (%) elevated from 78.4±2.1 and 25.6± 1.0 to 109.1±2.3 and 38.4±1.3 (P<0.05) respectively.Whereas in the control group,the same values decreased from 80.2±2.3 and 27.8±2.2 to 76.5±1.2 and 24.4±2.5(P<0.05) respectively.So we could observe remarkable difference between the two groups.Between the two groups there were no significant difference on renal function and blood pressure. In the treatment group,echocardiography showed LVEDD decreased from (53.1±3.7) mm to (49.5±2.4) mm,LVESD decreased from (34.9±2.7) mm to (32.5±2.7) mm,IVST decreased from (11.1±0.9) mm to (10.3±1.3) mm,LVPWT decreased from (11.8±1.3) mm to (10.7±0.7) mm,LAD decreased from (40.2±4.1) mm to (37.7±2.5) mm (P<0.05).Whereas in the control group the left ventricular hypertrophy progressed,LVEDD increased from (52.1±2.9) mm to (56.7±3.1) mm,LVESD increased from (34.5±2.6) mm to (36.7±3.4) mm,IVST increased from (10.8±1.2) mm to (12.6±1.7) mm,LVPWT increased from (11.5±1.7) mm to (13.7±1.2) mm,LAD increased from (39.6±4.1) mm to (43.2±3.0) mm (P<0.05).Therefore there were significant differences between the two groups (at the end of 6 months and 12 months). Conclusions The administration of EPO can improve left ventricular hypertrophy without impairment of renal function in

关 键 词：左心室肥大 慢性肾衰竭 阿法依泊汀 透析前 患者 血红蛋白(Hb) 促红细胞生成素 左室后壁厚度 肾功能不全 红细胞压积 心动超声图 超声心动图 室间隔厚度 左心室肥厚 肾功能损伤 EPO 治疗组 对照组 alfa 皮下注射 补充铁剂 

分 类 号：R544.1[医药卫生—心血管疾病] R692.5[医药卫生—内科学]