微炎症状态对血液透析患者促红细胞生成素疗效的影响

目的对微炎症状态下重组人促红细胞生成素(recombinant human erythropoietin,r-HuEPO)治疗维持性血液透析(maintain hemodialysis,MHD)患者肾性贫血的疗效进行分析,探讨影响r-HuEPO疗效的相关因素。方法根据血清高敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)的数值,将54例MHD患者分为2组:微炎症组(hs-CRP5mg/L)和非微炎症组(hs-CRP≤5mg/L),测定血红蛋白(hemoglobin,Hb)、血细胞比容(hematocrit,Hct)、hs-CRP、白细胞介素6(interleukin-6,IL-6)、血清铁蛋白(serum ferritin,SF)、血清白蛋白(albumin,Alb)、血清肌酐(serum creatinine,SCr)和全段甲状旁腺激素(intact parathyroid hormone,iPTH)的水平,计算各指标均值,并比较两组间的差异;以r-HuEPO的用量[IU/(kg·周)]与Hct的比值(EPO/Hct)作为EPO反应性的指标,对影响EPO反应性的指标进行多因素分析。结果 54例MHD患者中,29例(53.7%)hs-CRP升高(微炎症组),25例(46.3%)正常(非微炎症组),微炎症组的hs-CRP、IL-6和EPO/Hct比值水平均显著高于非微炎症组(P0.01),Hb和Hct显著低于非微炎症组(P0.05);单因素相关性分析显示EPO反应性(EPO/Hct)与hs-CRP、IL-6和iPTH呈正相关,与Alb呈负相关;多因素逐步线性回归分析显示,hs-CRP升高是影响EPO反应性的独立危险因素。结论微炎症状态是影响MHD患者r-HuEPO疗效的重要因素。

Microinflammation status on the effects of erythropoietin therapy in patients on hemodialysis

Objective To observe the effects of recombinant human erythropoietin （r-HuEPO） therapy on renal anemia,and to investigate the factors relating to the effects of r-HuEPO in maintenance hemodialysis patients. Methods Based on the serum high sensitivity C-reactive protein （Hs-CRP） level,54 maintenance hemodialysis patients were divided into microinflammation group （Hs-CRP5mg/L） and non-microinflammation group （Hs-CRP5mg/L）. Their hemoglobin （Hb）,hematocrit （Hct）,and serum Hs-CRP,interleukin-6 （IL-6）,ferritin （SF）,albumin （Alb）,creatinine （SCr） and immunoreactive parathyroid hormone （iPTH） were measured. The ratio of r-HuEPO IU/kg/week to Hct （EPO/Hct） was used as the parameter for the responsiveness to r-HuEPO. Results Patients in the microinflammation group （29 cases,53.7%） showed higher IL-6 and EPO/Hct ratio,but lower Hb and Hct,as compared with those in the non-microinflammation group （25 cases,46.3%）. Simple correlation analysis found that Hs-CRP,IL-6,iPTH and Alb were associated with the EPO/Hct ratio. Multiple stepwise regression analysis indicated that increased Hs-CRP was the independent risk factor on responsiveness to r-HuEPO. Conclusion Microinflammation status is one of the complications in maintenance hemodialysis patients. High level of Hs-CRP is an important factor causing hypo-responsiveness to r-HuEPO.