β地中海贫血对血液透析患者使用重组人促红细胞生成素疗效的影响

目的探讨β地中海贫血对血透患者使用重组人促红细胞生成素(rHuEPO)改善贫血疗效的影响。方法选择伴β地中海贫血血透患者为地贫组,并选择性别、年龄等情况相似的血透患者为对照组,两组患者按常规剂量rHuEPO 120～150 IU/(kg.周)治疗3个月;3个月后,如地贫组患者血红蛋白未达标(≥110 g/L),则改用大剂量rHuEPO 200～250 IU/(kg.周)治疗3个月。结果 10例地贫组患者和10例对照组患者在治疗前血红蛋白水平差异无统计学意义,3个月常规剂量rHuEPO治疗期间rHuEPO剂量差异无统计学意义(P>0.05),但每月末地贫组血红蛋白水平明显比对照组低(P<0.01);3个月后,对照组患者贫血基本纠正,而地贫组患者血红蛋白水平虽比治疗前有所改善(P<0.01),但贫血未能纠正。后3个月地贫组患者使用大剂量rHuEPO治疗,血红蛋白水平从第1月末开始明显上升(P<0.01),并持续至第3月末,患者贫血得以纠正;期间除引起患者血压升高外未出现不可控制的恶性高血压、内瘘堵塞等严重并发症。结论β地中海贫血会影响血透患者使用rHuEPO改善贫血的疗效,大剂量rHuEPO能纠正伴β地中海贫血的血透患者贫血。

Effects of beta-thalassemia minor on the efficacy of erythropoietin in hemodialysis patients

Objective To investigate the effects of beta-thalassemia minor on the efficacy of erythropoietin to ameliorate anemia in hemodialysis patients. Methods The hemodialysis patients with beta-thalassemia minor(thalassemic group) and the matched hemodialysis patients without beta-thalassemia minor(control group) were initially treated with erythropoietin 120~150 IU/(kg·week)] subcutaneous injection for three months.After three months of treatment,a high dose of erythropoietin 200~250 IU/(kg·week)] was applied for followed three months,if the hemoglobin levels less than 110 g/L in thalassemic group. Results There was no significant difference revealed in baseline hemoglobin level and therapeutic erythropoietin dose between thalassemic group and control group.However,the hemoglobin level of patients in thalassemic group was significantly lower than that in control group at each ends of the three months(P<0.01).After three months therapy of routine dose erythropoietin,the anemia of patients in control group was corrected.Although hemoglobin level thalassemic group was significantly improved(P<0.01),the anemia was not corrected.Within the three months of high dose erythropoietin,the hemoglobin level in thalassemic group was significantly increased at the end of the first month(P<0.01) till the end of the third month when the anemia corrected.The high dose erythropoietin may lead to high blood pressure,but no uncontrolled hypertension,arteriovenous fistula thrombus or other severely adverse events was observed. Conclusion The beta-thalassemia minor reduces the efficacy of erythropoietin in treatment of hemodialysis patients,which could be corrected with a high dose of erythropoietin.