高通量血液透析治疗在维持性血液透析伴肾性贫血患者中的应用分析  

Application of high throughput hemodialysis in maintenance hemodialysis patients with renal anemia

作　　者：李妍 吴志平 倪晨 李悦达 王萍 Li Yan;Wu Zhiping;Ni Chen;Li Yueda;Wang Ping(Department of Nephrology,the Third People′s Hospital of Hangzhou City(Hangzhou Third Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine),Hangzhou 310000,China)

机构地区：[1]杭州市第三人民医院(浙江中医药大学附属杭州第三医院)肾内科,杭州310000

出　　处：《中国医师进修杂志》2024年第9期828-834,共7页Chinese Journal of Postgraduates of Medicine

基　　金：杭州市医药卫生科技项目(A20200005)。

摘　　要：目的分析高通量血液透析(HFHD)治疗对于维持性血液透析(MHD)伴肾性贫血患者血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)、铁调素(Hepc)以及可溶性转铁蛋白受体(sTfR)水平的应用效果。方法前瞻性选择2020年8月至2023年7月杭州市第三人民医院新导入的MHD治疗的60例尿毒症患者作为研究对象,根据治疗方式将其分为高通量组和低通量组各30例,收集一般资料,观察两组贫血指标[红细胞计数(RBC)、血红蛋白(Hb)、红细胞压积(HCT)、网织红细胞百分比(Ret)]、铁代谢指标(SF、TSAT、Hepc及sTfR)、炎性指标[β2微球蛋白(β2-MG)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]、肾功能指标[(血肌酐(SCr)、尿肌酐(Cr)、尿素氮(BUN)]以及不良反应发生情况。结果高通量组治疗后与治疗前相比RBC、Hb、HCT、SF、TSAT水平均有所升高[(3.33±0.43)×10^(12)/L比(2.12±0.24)×10^(12)/L、(118.08±11.36)g/L比(98.23±8.58)g/L、0.354±0.030比0.228±0.037、(486.23±68.22)μg/L比(149.34±39.62)μg/L、(36.24±5.82)%比(18.72±6.14)%],低通量组治疗后与治疗前相比RBC、Hb、HCT、SF、TSAT水平均有所升高[(2.79±0.32)×10^(12)/L比(2.19±0.27)×10^(12)/L、(111.98±9.07)g/L比(97.60±8.33)g/L、0.330±0.036比0.214±0.037、(332.73±56.35)μg/L比(151.25±39.90)μg/L、(22.23±6.60)%比(17.97±5.72)%]。高通量组治疗后与治疗前相比,Ret、Hepc、sTfR、β2-MG、CRP、IL-6、SCr、Cr、BUN水平均有所下降[(1.02±0.58)%比(1.64±0.99)%、(71.56±5.67)μg/L比(89.56±7.62)μg/L、(395.07±37.10)μg/L比(471.37±41.18)μg/L、(8.38±1.94)μg/L比(13.79±2.09)μg/L、(1.07±0.23)mg/L比(2.28±0.20)mg/L、(11.40±2.84)ng/L比(22.74±6.38)ng/L、(351.54±62.05)μmol/L比(530.04±85.06)μmol/L、(6.32±1.49)nmol/L比(11.52±2.37)nmol/L、(6.75±1.51)mmol/L比(18.37±4.52)mmol/L],低通量组治疗后与治疗前相比,Ret、Hepc、sTfR、β2-MG、CRP、IL-6、SCr、Cr、BUN水平有所下降[(1.40±0.65)%比(1.67±0.78)%、(84.33±7.45)μg/L比(88.9Objective To analyze the efficacy of high-throughput hemodialysis(HFHD)therapy on the application of serum ferritin(SF),transferrin saturation(TSAT),ferromodultin(Hepc)and soluble transferrin receptor(sTfR)levels in maintenance hemodialysis(MHD)with renal anemia.Methods The uremic patients with MHD treatment in the Third People′s Hospital of Hangzhou City from August 2020 to July 2023 were selected as the study object.They were divided into high throughput(30 cases)and low throughput(30 cases)according the treatment methods.The general data;anemia indexes,including red blood cell count(RBC),hemoglobin(Hb),hematocrit(HCT),percentage of reticulocytes(Ret);iron metabolism indexes(SF,TSAT,Hepc and sTfR);inflammations indexes,includingβ2-microglobulin(β2-MG),C-reactive protein(CRP),interleukin-6(IL-6);renal function indexes,including blood creatinine(SCr),urine creatinine(Cr),blood urea nitrogen(BUN);and adverse reaction were collected.Results After treatment,the levels of RBC,Hb,HCT,SF and TSAT in the high-throughput group were increased compared with those before treatment:(3.33±0.43)×10^(12)/L vs.(2.12±0.24)×10^(12)/L,(118.08±11.36)g/L vs.(98.23±8.58)g/L,0.354±0.030 vs.0.228±0.037,(486.23±68.22)μg/L vs.(149.34±39.62)μg/L,(36.24±5.82)%vs.(18.72±6.14)%,After treatment,the levels of RBC,Hb,HCT,SF and TSAT in the low-throughput group were increased compared with those before treatment:(2.79±0.32)×10^(12)/L vs.(2.19±0.27)×10^(12)/L,(111.98±9.07)g/L vs.(97.60±8.33)g/L,0.330±0.036 vs.0.214±0.037,(332.73±56.35)μg/L vs.(151.25±39.90)μg/L,(22.23±6.60)%vs.(17.97±5.72)%.In the high-throughput group,after treatment compared with before treatment,Ret,Hepc,sTfR,β2-MG,CRP,IL-6,SCr,Cr and BUN levels all decreased:(1.02±0.58)%vs.(1.64±0.99)%,(71.56±5.67)μg/L vs.(89.56±7.62)μg/L,(395.07±37.10)μg/L vs.(471.37±41.18)μg/L,(8.38±1.94)μg/L vs.(13.79±2.09)μg/L,(1.07±0.23)mg/L vs.(2.28±0.20)mg/L,(11.40±2.84)ng/L vs.(22.74±6.38)ng/L,(351.54±62.05)μmol/L vs.(530.04±85.06)μmol/L,(6.32±1.4

关 键 词：血液透析滤过 肾性贫血 铁蛋白 铁调素 

分 类 号：R692.5[医药卫生—泌尿科学] R556[医药卫生—外科学]