促红细胞生成素对慢性肾脏病非透析患者脂质代谢的影响研究

目的：评价慢性肾脏病（chronic kidney disease,CKD）非透析患者使用促红细胞生成素（EPO）对脂质代谢的影响。方法：120例CKD非透析患者患者,其中治疗组71例,皮下注射EPO10000U,每周1次,血红蛋白（Hb）升高至110g.L^-1后,改为隔周1次;对照组49例,不使用EPO。两组同时补充铁剂和叶酸,但不服用任何降血脂药。随访期12个月。随访期每月检查肾功能、电解质、血常规,每3个月检查总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）及脂蛋白（a）（Lp（a））。结果：经过12个月随访,治疗组TC、LDL-C、Lp（a）均较治疗前显著降低,分别由治疗前5.53±0.43mmol.L^-1、3.81±0.81mmol.L^-1、249±80.1mg.L^-1降到4.78±0.56mmol.L^-1、3.09±0.93mmol.L^-1、217±92.5mg.L^-1（P〈0.05）,TG略有下降,但差异无统计学意义（P〉0.05）;对照组TC、TG、LDL-C、Lp（a）在观察期结束也有不同程度下降,但仅TC有显著下降（5.67±0.76mmol.L^-1和5.27±0.72mmol.L^-1,P〈0.05）;两组之间比较治疗组TC下降更显著（P〈0.05）;EPO治疗组HDL-C显著升高（1.31±0.25mmol.L^-1和1.82±0.29mmol.L^-1,P〈0.05）,而对照组无明显改变,治疗组治疗后HDL-C显著高于对照组。结论：CKD非透析患者用EPO能改善脂质代谢异常。

Effects of Erythropoietin on the Lipid Metabolism in Pre-dialysis Patients

Objective：To investigate the effects of erythropoietin （EPO） administration on lipid metabolism in pre dialysis patients with chronic kidney disease（CKD）. Methods： Totally 120 pre-dialysis patients with CKD were enrolled. Among which,71 patients were treated with EPO, subcutaneous injection, initially 10000 U once a week and later once every two weeks after hemoglobin ≥110 g ·L^-1 . The remaining 49 patients who did not receive EPO treatment were taken as control group. Folie acid and iron were suppled orally in both groups, but lipid-lowering drugs were not suppled. In the observation period of 1 year, renal function, electrolyte,blood routine examination, blood pressure were measured every month, serum level of TC,TG, LDL-C, HDL-C,LP-a were measured every three months. Results： At the end of the study of 12 months, serum levels of TC, LDL- C,Lp（a） significantly decreased from 5.53±0.43 mmol· L^-1, 3.81±0.81 mmol· L^-1, 249 ±80.1 mg·L^-1 to 4.78±0.56 mmol · L^-1 , 3.09 ± 0.93 mmol · L^-1 , 217 ± 92.5mg· L^-1 respectively in EPO treatment group（P〈0.05）. TG only decreased sligthly（P〉0.05）. In control group, TC, TG, LDL-C, Lp （a） decreased in varying degrees, but only TC decreased significantly（5.67 ±0.76 vs. 5.27 ±0.72 mmol · L^-1 ,P〈0. 05）. TC decreased more significantly in the treatment group compared with the control group （P〈0.05）. However, serum HDL-C levels significantly increased in treatment group （1. 31 ± 0.25vs. 1.82 ± 0.29 mmol · L^-1 , P〈 0.05） , whereas they remained unchanged in control group. The change was also significantly differant between two groups. Conclusions： Our results indicate that EPO treatment could improve the lipid metabolism in pre-dialysis patients with CKD.