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目的 :了解促红细胞生成素和血管紧张素转换酶抑制剂对维持性血透 (HD)患者红细胞的影响 ,为临床更合理治疗肾性贫血提供依据。 方法 :78例维持性HD患者随机分成HD组、HD +EPO组、HD +ACEI组和HD+EPO +ACEI组四组 ,分别在治疗前、治疗后 3个月空腹抽血检测血红蛋白 (Hb)、红细胞压积 (Hct)、红细胞ATP酶(Na+ K+ATP酶、Ca2 + ATP酶 )活性、血浆谷光甘肽过氧化物酶 (GSH PX)活力及红细胞脂质过氧化物丙二醛 (MDA)含量。 结果 :与HD组比较 ,HD +EPO组治疗后 ,Hb、Hct、红细胞ATP酶 (Na+ K+ATP酶、Ca2 + ATP酶 )活性和血浆GSH PX活力明显升高 ,差异显著 (P <0 0 1) ;红细胞MDA明显降低 ,差异显著 (P <0 0 1)。HD +ACEI治疗后 ,Hct有所下降 ,存有差异 (P <0 0 5 ) ,而Hb、红细胞ATP酶 (Na+ K+ATP酶、Ca2 + ATP酶 )活性、血浆GSH PX活力、红细胞MDA含量均无明显差异 (P >0 0 5 )。 结论 :CRF维持性HD患者经促红细胞生成素治疗后 ,不仅红细胞数量明显升高 ,而且通过提高红细胞ATP酶活性、血浆谷光甘肽过氧化物酶活力 ,减少红细胞脂质过氧化物含量改善红细胞的形态和功能 ,延长红细胞寿命 ,纠正贫血。而血管紧张素转换酶抑制剂则有减少红细胞数量 ,加重贫血的趋势 ,但其对红细胞的形态和功能影响不大。
Objective: To understand the effect of erythropoietin and angiotensin-converting enzyme inhibitors on erythrocytes in patients with maintenance hemodialysis (HD), and to provide basis for clinical treatment of renal anemia. Methods: Seventy-eight patients with maintenance HD were randomly divided into HD group, HD + EPO group, HD + ACEI group and HD + EPO + ACEI group. The levels of hemoglobin (Hb) , Hematocrit (Hct), erythrocyte ATPase (Na + K + ATPase, Ca2 + ATPase) activity, plasma glutathione peroxidase (GSH PX) activity and erythrocyte lipid peroxidation )content. Results: Compared with HD group, the activities of Hb, Hct, erythrocyte ATPase (Na + K + ATPase, Ca2 + ATPase) and plasma GSH PX in HD + EPO group were significantly increased 1); Red blood cell MDA decreased significantly (P <0.01). Hct decreased after HD + ACEI treatment (P <0 05), while Hb, erythrocyte ATPase (Na + K + ATPase, Ca 2+ ATPase) activity, plasma GSH PX activity, erythrocyte MDA content No significant difference (P> 0.05). CONCLUSIONS: After treatment with erythropoietin, patients with CRF-sustaining HD not only show a significant increase in the number of red blood cells, but also improve erythrocytes by increasing ATPase activity of erythrocytes, plasma glutathione peroxidase activity and reducing lipid peroxidation of erythrocytes The shape and function, extend the life span of red blood cells, correct anemia. Angiotensin-converting enzyme inhibitors reduce the number of red blood cells and aggravate the tendency of anemia, but have little effect on the morphology and function of red blood cells.