继发性甲状旁腺功能亢进症对肾性贫血的影响

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。

Effects of secondary hyperparathyroidism treatment on renal anemia

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.