不同血液净化方式对维持性血液透析患者贫血治疗的影响

目的比较单纯血液透析与血液透析联合血液灌流治疗对维持性血液透析（maintenance hemodialysis，MHD）患者贫血治疗的影响。方法选择2013年4月至11月在我院血液净化中心MHD患者40例，入组前患者均每周3次行单纯血液透析治疗，并使用促红细胞生成素刺激剂（eryhropoises stimulating agent，ESA）纠正贫血。按照随机数表法将MHD患者40例分为单纯血液透析（hemodialysis，HD）治疗组（HD组）和血液透析联合血液灌流（hemoperfusion，HP）治疗组（HD＋HP组），每组20例。HD组仍每周3次均行HD治疗；HD＋HP组每周行2次HD治疗，1次HD＋HP治疗，仍继续使用ESA；治疗12周。记录2组患者治疗前、后血红蛋白（hemoglobin，Hb），ESA用量，计算ESA抵抗指数（ESA resistant index，ESARI）评价ESA治疗的反应，同时检测2组治疗前、后血清铁、白蛋白（albumin，Alb）、C反应蛋白（c-reactiveprotein，CRP）、全段甲状旁腺素（intact parathyroidism hormone，iPTH）水平及透析治疗的单室模型尿素清除指数（singlepool Kt／V，spKt／V）。结果40例患者均随访至第12周末。第12周时，HD＋HP组患者Hb水平较基线时显著升高[（119．27±12．16）g／L比（106．59±6．51）g／L，（P〈0．01）]，而ESA剂量低于基线时水平[（76．99±16．6）IU·W^-1·kg^-l比（128．96±33．47）IU·w^-1·kg^-1（P〈0．05）]，ESARI亦低于基线时水平[（0．56±0．20）比（1．30±0．47），（P〈0．01）]。第12周时HD＋HP组患者的iPTH水平较基线时显著降低[（161．09±63．70）ng／L比（256．23±56．77）ng／L，（P〈0．01）]，CRP水平较基线时降低[（4．65±1．32）mg／L比（7．55±3．23）mg／L，（P〈0．05）]；而第12周时HD组患者的Hb水平、ESA用量、ES—ARI值及iPTH、CRP水平与基线时比较无统计学差异（P〉0．05）。结论HD联合HP治疗较单纯HD治疗能更有效清除CRP、iPTH，提高MHD患者对ESA治疗的反应性，减少ESA使用剂量，改善MHD患者纠正贫血治疗的效果。

Effect of different blood purification modes on the treatment of renal anemia in maintenance hemodialysis patients

Objective To observe the effect of two different blood purification therapies on the treatment of renal anemia in maintenance hemodialysis （MHD） patients. Methods From April 2013 to November 2013, 40 patients with simple hemodialysis treatment （3 times/week） in the recent 3 months were enrolled and accepted the eryhropoises stimulating agent （ESA） treatment. The patients were randomly divided into two groups.. MHD group continuously given simple hemodialysis treatment （3 times/week）,and MHD ＋ HP group given simple hemodialysis treatment （2 times/week） and hemodialysis combined with hemoperfusion treatment （1 time/week）. ESA was continuously used to rectify renal anemia. The treatment lasted for 12 weeks. A series biochemical tests were performed before and after treatment in the two groups. The levels of hemoglobin （Hb）, albumin （Alb）,C-reactive pro- tein （CRP）, ferrum （Fe）,intact parathyroidism hormone （iPTH） and the dosage of ESA were recor- ded, and the ESA resistant index （ESARI） was calculated to evaluate the response of ESA and the sp- Kt/V value to evaluate the effect of hemopurification. Results After treatment for 12 weeks in all the 40 patients, Hh level in HD ＋ HP group was significantly increased E（119.27 ± 12. 16） g/L vs. （106. 59±6. 51） g/L,P〈0. 011, the dosage of ESA was decreased [-（76. 99 ±16. 6） IU/w/kg vs. （128. 96 ± 33. 47） IU/w/kg, P〈0. 051, and ESARI was also decreased E〈0. 56 ± 0. 20） vs. （1.30 ± 0. 47）, P〈0. 01）. The values of iPTH and CRP after treatment for 12 weeks in HD＋ HP group were also decreased E（161.09 ± 63.7） ng/L vs. （256. 23 ±56. 77） ng/L,P〈0. 01 ） and （4. 65 ± 1.32） mg/ L vs. （7. 55 ± 3. 23） mg/L,P〈0. 05）. After the treatment, the value of Hb the dosage of ESA, the value of ESARI, the value of iPTH and CRP in HD group had no changes. changes Hemodialysis combined with hemopurification can clear the CRP, and CRP more effectively, and it can improve the patients response to ESA and reduce the dosage of ESA.