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目的:探讨在维持性血液透析(maintenance hemodialysis,MHD)患者中微炎症状态对重组人促红细胞生成素(recombinant human erythropoietin,r-HuEPO)治疗肾性贫血的影响。方法:53例患者根据血清超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)的水平分为微炎症组(hs-CRP>3 mg/L,n=30)和非炎症组(hs-CRP≤3 mg/L,n=23),测定血红蛋白(hemoglobin,Hb)、血细胞比容(hematocrit,Hct)、r-HuEPO的用量[U/(kg.week)]与Hct的比值(EPO/Hct)、hs-CRP、血清肌酐(serum creatinine,Scr)、血清铁蛋白(serum ferritin,SF)、转铁蛋白饱和度(transferrin saturation,TS)、血清白蛋白(albumin,Alb)、尿素清除指数(urea remove index,KT/V)和全段甲状旁腺激素(intact parathyroid hormone,iPTH)的水平,采用独立样本t检验比较两组间的差异;以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:微炎症组hs-CRP升高,非炎症组正常,微炎症组的hs-CRP水平显著高于非炎症组(P<0.01),微炎症组的年龄、EPO/Hct水平显著高于非炎症组(P<0.05);多元相关性分析显示EPO反应性(EPO/Hct)与hs-CRP(r=0.538,P<0.01)、KT/V(r=0.277,P<0.05)呈显著正相关,与Alb(r=–0.605,P<0.01)和Scr(r=–0.291,P<0.05)呈显著负相关;多元逐步回归分析显示,hs-CRP和白蛋白是影响EPO反应性的相关危险因素(R2=0.424,P<0.01)。结论:MHD患者存在微炎症状态,微炎症状态是影响MHD患者r-HuEPO反应性的重要因素。
Objective: To investigate the effect of microinflammatory state of recombinant human erythropoietin (r-HuEPO) on renal anemia in patients with maintenance hemodialysis (MHD). Methods: Fifty-three patients were divided into micro-inflammation group (hs-CRP> 3 mg / L, n = 30) and non-inflammation group according to the level of serum hs-CRP The ratio of hemoglobin (Hb), hematocrit (Hct) and r-HuEPO [U / (kg.week)] to Hct EPO / Hct, hs-CRP, serum creatinine (Scr), serum ferritin (SF), transferrin saturation (TS), albumin (ALB) (KT / V) and intact parathyroid hormone (iPTH) levels were compared by using independent samples t-test to compare the differences between the two groups; EPO / Hct was used as an index of EPO reactivity , Multivariate analysis of the indicators that affect the reactivity of EPO. Results: The levels of hs-CRP in micro-inflammation group were higher than those in non-inflammation group. The levels of hs-CRP in micro-inflammation group were significantly higher than those in non-inflammation group (P <0.01) Multivariate correlation analysis showed that EPO / Hct and hs-CRP (r = 0.538, P <0.01), KT / V (r = 0.277, P <0.05) (R = -0.691, P <0.01) and Scr (r = -0.291, P <0.05). The multivariate stepwise regression analysis showed that hs-CRP and albumin were related to the effects of EPO reactivity Risk factors (R2 = 0.424, P <0.01). Conclusions: Micro-inflammatory status exists in patients with MHD and micro-inflammatory status is an important factor affecting r-HuEPO reactivity in patients with MHD.