甲状旁腺激素与血液透析患者促红细胞生成素疗效的关系  

Effect of the parathyroid hormone on the responsiveness to erythropoietin in hemodialysis patients

作　　者：张磊[1] 崔美玉[1] 许冬梅[1] 李文斌[1] 王尊松[1] 魏勇[1] 朱竹先[1] 

机构地区：[1]山东省千佛山医院肾内科,济南250014

出　　处：《中国血液净化》2009年第4期203-205,共3页Chinese Journal of Blood Purification

摘　　要：目的探讨维持性血液透析患者免疫反应性甲状旁腺激素(iPTH)与贫血和促红细胞生成素(EPO)疗效的关系。方法46例维持性血液透析患者于透析日空腹采血测定血红蛋白(Hb)、红细胞比积(Hct)、血清铁蛋白(SF)、C反应蛋白(CRP)、血清钙(Ca)、磷(P)、钙磷乘积(Ca×P)以及血浆白蛋白(Alb)、肌酐(Scr)和iPTH,记录重组人促红细胞生成素(r-HuEPO)用量,以r-HuEPO用量/Hct比值(EPO/Hct)作为EPO低反应指标。结果46例患者中20例(占43.5%)iPTH升高(iPTH增高组),26例(占56.5%)正常(iPTH正常组),iPTH增高组EPO/Hct比值、磷(P)、钙磷乘积(Ca×P)和iPTH水平均高于iPTH正常组,Hct、Hb低于PTH正常组;多因素逐步线性回归分析表明,影响EPO/Hct比值的因素有iPTH、年龄和透析疗程(R2=0.388,P=0.039)。结论继发性甲状旁腺功能亢进是维持性血液透析患者常见并发症之一,甲状旁腺激素升高是影响促红细胞生成素疗效的主要因素之一。Objective To investigate the correlation of serum immunoreactive parathyroid hormone （iPTH） with anemia and hypo-responsiveness to erythropoietin （EPO） in maintenance hemodialysis patients. Methods We studied 46 maintenance hemodialysis patients （28 males and 18 females, aged 61.00±15.59 years）. Blood samples were collected at the day on hemodialysis for the determination of serum hemoglobin （Hb）, hematocrit （Hct）, albumin, ferritin, Ca, P, creatinine and iPTH. Higher ratio of recombinant human erythropoietin （r-HuEPO） dosage to Hct （EPO/Hct） was defined as hypo-responsiveness to EPO. Results Patients with elevated serum iPTH （20 cases, 43.5%） showed higher EPO/Hct ratio, serum P and Ca x P product, but lower Hb and Hct, as compared with those of the patients with normal serum iPTH （26 cases, 56.5%）. Multiple stepwise regression analysis found that serum iPTH level, patient＇s age and hemodialysis duration were the best predictors for EPO/Hct ratio （R2=0.388, P=0.039）. Conclusion Secondary hyperparathyroidism is one of the complications in maintenance hemodialysis patients. Oversecretion of PTH is the most important factor causing hypo-responsiveness to EPO.

关 键 词：肾性贫血 血液透析 甲状旁腺激素 促红细胞生成素低反应 

分 类 号：R318.16[医药卫生—生物医学工程]