大剂量人重组红细胞生成素对维持性血液透析患者不良事件的风险因素分析  

Risk factors analysis of adverse events in maintenance of hemodialysis patients with high-dose human recombinant erythropoietin

作　　者：谢心苗 王永兰 曾楚楚 朱鼎玉 张楠[1] 王筱霞[1] 陈琪婕 XIE Xin-miao;WANG Yong-lan;ZENG Chu-chu;ZHU Ding-yu;ZHANG Nan;WANG Xiao-xia;CHEN Qi-jie(Renal Division,Tongren Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200336,China)

机构地区：[1]上海交通大学医学院附属同仁医院,上海200336

出　　处：《伤害医学（电子版）》2023年第2期53-60,共8页Injury Medicine(Electronic Edition)

基　　金：长宁区“优质+均衡”科研人才项专项(CNJH202109)。

摘　　要：目的本文通过探讨维持性血液透析(maintenance hemodialysis,MHD)患者人重组红细胞生成素(rHuEPO)用量的影响因素,为降低大剂量rHuEPO对患者带来的相关伤害提供临床参考。方法收集所有2020年1月1日至1月31日间正在上海交通大学医学院附属同仁医院血液净化中心进行维持性血液透析患者的临床诊疗记录,其中包括人口统计学资料、rHuEPO用量、临床生化指标、单室尿素清除率(sp Kt/V)及尿素下降率(URR)。以rHuEPO为因变量进行多元线性回归分析。结果本研究共纳入205例患者,其中男性128例(62.4%),平均年龄为65.75±12.69岁,平均透析龄29月,其中有67例(32.7%)患者合并糖尿病。入组患者rHuEPO周剂量的中位数为195.96 U/kg·w,多元线性回归分析显示血清白蛋白(B:0.748,95%CI:0.652~0.858,P<0.001)、sp Kt/V(B:0.732,95%CI:0.554~0.968,P=0.029)与rHuEPO周剂量独立相关。结论维持性血液透析患者的营养状态、透析充分性与患者的rHuEPO用量独立相关,可通过改善患者营养状态,提高透析充分性,以减少rHuEPO用量,从而降低大剂量rHuEPO所致的不良事件对患者的伤害。Objective This article explores the influencing factors of the dosage of recombinant human erythropoietin(rHuEPO)in maintenance of hemodialysis(MHD)patients,in order to provide clinical reference for reducing complications related injuries caused by high-dose of rHuEPO to patients.Methods MHD patients in the Tongren Hospital from January 1,2020 to January 31,2020,with complete data were enrolled.Demographic parameters and rHuEPO doses were collected and clinical biochemical indicators were measured.spKt/V and URR were applied to evaluate the hemodialysis adequacy.Multiple linear regression analysis was performed with rHuEPO as the dependent variable.Results A total of 205 patients were enrolled.Among them,128 patients(62.4%)were male,with the mean age 65.75±12.69 years.Their mean dialysis age was 29months.There were 67 cases(32.7%)with diabetes.The median rHuEPO dose was 195.96 U/kg·w.Multiple linear regression showed that serum albumin(B:0.748,95%IC:0.652~0.858,P<0.001)and spKt/V(B:0.732,95%IC:0.554~0.968,P=0.029)independently associated with rHuEPO dose.Conclusions The nutritional status and dialysis adequacy of maintenance hemodialysis patients were independently related to their rHuEPO dosages.The results suggest that improving the patient's nutritional status and dialysis adequacy reduced the rHuEPO dosages,thereby reducing the harm of adverse events caused by high-doses of rHuEPO to patients.

关 键 词：人促红细胞生成素 维持性血液透析 营养状态 透析充分性 不良事件 

分 类 号：R692[医药卫生—泌尿科学]