缬沙坦对维持性血液透析患者促红细胞生成素疗效的影响

目的探讨缬沙坦对血液透析患者促红细胞生成素（erythropoietin,EPO）疗效的影响。方法选择济南市中心医院友谊肾脏病/血液净化中心维持性血液透析伴有高血压的患者共55例,其中长期接受EPO治疗者40例随机分为A、B组;不接受EPO治疗及输血患者15例随机分为C、D组。A、C两组接受缬沙坦治疗;B、D两组作为对照。观察治疗前后患者Hb、Hct、EPO水平的变化,采用随机对照的方法进行前瞻性研究。结果A、B、D三组患者治疗前后血红蛋白（Hb）、红细胞压积（Hct）、EPO水平无显著性差异,C组患者治疗后Hb、EPO浓度明显降低。A组缬沙坦平均用药剂量大的11例患者治疗后Hb下降。结论缬沙坦可能通过抑制内源性EPO的产生而加重贫血;小剂量缬沙坦一般不影响外源性EPO的疗效,而大剂量的缬沙坦对外源性EPO的疗效可能有一定的影响。

The effect of Valsartan on erythropoietin in the treatment of maintenance hemodialysis patients

Objective To investigate Valsartan on the effect of erythropoietin （EPO） in the treatment of maintenance hemodialysis patients with anemia. Methods A total of 55 patients undergoing hemodialysis with stable clinical conditions and a hemoglobin level of 70-100g/L were enrolled in this study. They were assigned into 4 groups. Patients in groups A （n=20） and B （n=20） received EPO therapy, and those in groups C （n=8） and D （n=7） without the EPO therapy In addition, patients in groups A and C were treated with Valsartan, and those in groups B and D with Amlodipine. Hb, hematocrit （Hct）, and EPO levels were measured before and after the therapy. Results In groups A, B and D, no significant differences were found in the average Hb, Hct and EPO levels before and after the treatment for 6 months. In group C, however, Hb and EPO levels were significantly decreased after the treatment for 6 months. In group A, the decrease of Hb after the treatment was found in the 11 patients receiving higher dose of Valsartan. Conclusion Valsartan may cause the inhibition of endogenous EPO in hemodialysis patients. Lower dose of Valsartan does not alter the effect of exogenous EPO, but higher dose of Valsartan reduces the therapeutic effect of exogenous EPO in hemodialysis patients with anemia.