继发性甲状旁腺功能亢进症对肾性贫血的影响  

Effects of secondary hyperparathyroidism treatment on renal anemia

作　　者：马晓莉[1] 孙雪峰[1] 丁巍[2] 孙晓丹 曹雪莹[1] 张冬[1] 陈香美[1] 

机构地区：[1]解放军总医院肾内科,北京100853 [2]辽宁省鞍山市中心医院肾内科,辽宁鞍山114001 [3]北京市康复中心,北京100144

出　　处：《军事医学》2011年第3期211-213,共3页Military Medical Sciences

摘　　要：目的观察维持性血液透析患者继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)对肾性贫血的影响。方法给予34例维持性血液透析患者活性维生素D3或甲状旁腺切除术纠正SHPT,根据治疗效果分为组1[治疗后全段甲状旁腺激素(immunoreactive parathyroidism hormone,iPTH)≥350 ng/ml]和组2(治疗后iPTH<350 ng/ml)两组。观察治疗前后血红蛋白(hemoglobin,Hb)、血细胞比容(hematoccrit,Hct)、重组人促红细胞生成素用量/血细胞比容[recombinant human erythropoietin(r-HuEPO)dosage to Hct,EPO/Hct]的变化。结果 34例患者中,25例患者治疗后iPTH降至350 ng/ml以下(组2),9例患者iPTH仍明显高于350 ng/ml(组1)。组1及组2患者治疗前各参数比较无统计学差异,治疗后各参数比较,组2患者的Hb、Hct、EPO/Hct高于组1患者,差异有统计学意义。组2患者血清iPTH由(739.03±411.77)pg/ml降至(251.91±72.9)pg/ml,Hb由(104.32±9.56)g/L升至(116.44±7.37)g/L,Hct由(32.52±2.8)%升至(36.56±2.08)%,EPO/Hct值由(4.36±1.46)×104U降至(3.47±1.10)×104U,均P<0.05;组1患者治疗前iPTH(999.67±351.99)pg/ml、Hb(107±11.41)g/L、Hct(33.3±3.5)%、EPO/Hct值(4.36±1.46)×104U,治疗后iPTH(1029.3±281.041)pg/ml、Hb(106±11.12)g/L、Hct(32.8±3.3)%、EPO/Hct值(5.13±1.74)×104U,均P>0.05。结论 SHPT是引起EPO抵抗的一个重要因素,纠正维持性血液透析患者SHPT有利于肾性贫血的纠正。Objective To observe the effect of the secondary hyperparathyroidism（SHPT） treatment on renal anemia in hemodialysis patients.Methods Thirty-four patients with hemodialysis were given active vitamin D3 or parathyroid surgery to correct SHPT.According to the outcome of treatment,the patients were divided into two groups,group 1[immunoreactive parathyroidism hormone（iPTH）≥ 350 ng/ml after treatment],group 2（iPTH 350 ng/ml after treatment）.Then the values of hemogobin（Hb）,hematocrit（Hct）,the dosage of recombinant human erythropoietin（r-HuEPO） and r-HuEPO dosage to Hct（EPO/HCT） were compared before and after treatment.Results After treatment,the iPTH dropped below 350 ng/ml in 25 patients（group 2）,but was still well above 350 ng/ml in 9 patients（group 1）.No difference was observed between the two groups in parameters before treatment.After therapy,Hb,Hct,and EPO/Hct of patients in group 2 were significantly increased compared to group 1.In group 2,iPTH was decreased from（739.03±411.77）pg/ml to（251.91±72.9）pg/ml,Hb was increased from（104.32±9.56）g/L to（116.44±7.37）g/L,Hct was increased from（32.52±2.8）% to（36.56±2.08）%,and the ratio of EPO/Hct was decreased from（4.36±1.46）×104U to（3.47±1.10）×104U,P0.05.In group 1,before the treatment,iPTH,Hb,Hct and EPO/Hct ratio were（999.67±351.99）pg/ml,（107±11.41）g/L,（33.3±3.5）% and（4.36±1.46）% vs（1029.3±281.041）pg/ml,（106±11.12）g/L,（32.8±3.3）% and（5.13±1.74）×104 U,P0.05 after treatment.Conclusion SHPT is an important cause of EPO resistance.Correcting SHPT in hemodialysis patients could contribute to the treatment of renal anemia.

关 键 词：血液透析 肾性贫血 甲状旁腺功能亢进症 继发性 

分 类 号：R692.5[医药卫生—泌尿科学] R582.1[医药卫生—外科学]