老年维持性血液透析患者炎症氧化应激状态与贫血的关系

目的 评价老年维持性血液透析（MHD）患者炎症、氧化应激与贫血的关系.方法 选取2013年3月在我院治疗的MHD患者79例,其中包括年龄≥65岁老年患者48例及＜65岁的非老年MHD患者31例,透析龄均超过3个月,透析当日上机前空腹采血测定血红蛋白（Hb）、甲状旁腺激素（I-PTH）、高敏C反应蛋白（hs-CRP）、丙二醛（MDA）、超氧化物歧化酶（SOD）、血清白蛋白（Alb）水平及透析前后血尿素氮（BUN）,并根据透析时间、脱水量、干体重计算KT/V及尿素氮清除率（URR）,同时记录每周促红细胞生成素（EPO）、铁剂用量、透析时间.结果 老年组MHD患者贫血达标率为45.8％,明显低于非老年组的70.9％,维持相同血红蛋白水平需要皮下注射更大剂量重组人促红细胞生成素剂量（rHuEPO）（P＜0.05）;老年组MHD患者hs-CRP、MDA明显升高,SOD、Alb明显降低（P＜0.05）;老年贫血患者hs-CRP、MDA明显升高,SOD、Alb明显降低（P＜0.05）.结论 老年患者贫血达标率低,氧化应激状态是其贫血发生的主要原因,hs-CRP、SOD、MDA、Alb是反映老年MHD患者氧化应激的敏感指标.

Association between inflammation,oxidative stress and anemia in elderly patients with maintenance hemodialysis

Objective To evaluate the relationship between inflammation,oxidative stress and a- nemia in elderly patients with maintenance hemodialysis （MHD）. Methods Forty-eight elderly patients with MHD [ 19 females,29 males ; mean age （68.32 ± 6.72） years ] and 31 non-elderly patients with MHD [ 12 females, 19 males ; mean age （ 39.84 ±7.46） years ] were recruited in the study. Patients received regularly hemodialysis in preceding 3 months. Blood urea nitrogen（BUN） were collected at baseline, dial- ysis adequacy （Kt/V） and urea reduction rate （URR） were calculated after a single dialysis, hemoglobin （Hb） ,albumin（Alb）, intact parathyroid hormone（ iPTH）, as well as the oxidative stress parameters [ high-sensitivity C-reactive protein （ hs-CRP ）, malon-dialdehyde （ MDA ）, and superoxide dismutase （SOD） ] were measured before the dialysis. Doses of iron and EPO treatment were recorded. Results Rates of correction of anemia in elderly MHD patients were lower than those in the non-elderly controls, and compared with the non-elderly controls, higher doses of recombinant human erythropoietin （rHuEPO） were demanded to maintain a same Hb level in the elderly group. The elderly MHD patients with or with- out anemia had higher levels of hs-CRP and MDA,lower levels of SOD and Alb （ P 〈 O. 05 ）. Conclusion Anemia is common in the elderly MHD patients and not easy to correct. Oxidative stress is the main cause of anemia, and hs-CRP, SOD, MDA, Alb are sensitive index related to oxidative stress.