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目的观察维持性血液透析患者继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)对肾性贫血的影响。方法给予34例维持性血液透析患者活性维生素D3或甲状旁腺切除术纠正SHPT,根据治疗效果分为组1[治疗后全段甲状旁腺激素(immunoreactive parathyroidism hormone,iPTH)≥350 ng/ml]和组2(治疗后iPTH<350 ng/ml)两组。观察治疗前后血红蛋白(hemoglobin,Hb)、血细胞比容(hematoccrit,Hct)、重组人促红细胞生成素用量/血细胞比容[recombinant human erythropoietin(r-HuEPO)dosage to Hct,EPO/Hct]的变化。结果 34例患者中,25例患者治疗后iPTH降至350 ng/ml以下(组2),9例患者iPTH仍明显高于350 ng/ml(组1)。组1及组2患者治疗前各参数比较无统计学差异,治疗后各参数比较,组2患者的Hb、Hct、EPO/Hct高于组1患者,差异有统计学意义。组2患者血清iPTH由(739.03±411.77)pg/ml降至(251.91±72.9)pg/ml,Hb由(104.32±9.56)g/L升至(116.44±7.37)g/L,Hct由(32.52±2.8)%升至(36.56±2.08)%,EPO/Hct值由(4.36±1.46)×104U降至(3.47±1.10)×104U,均P<0.05;组1患者治疗前iPTH(999.67±351.99)pg/ml、Hb(107±11.41)g/L、Hct(33.3±3.5)%、EPO/Hct值(4.36±1.46)×104U,治疗后iPTH(1029.3±281.041)pg/ml、Hb(106±11.12)g/L、Hct(32.8±3.3)%、EPO/Hct值(5.13±1.74)×104U,均P>0.05。结论 SHPT是引起EPO抵抗的一个重要因素,纠正维持性血液透析患者SHPT有利于肾性贫血的纠正。
Objective To investigate the effect of secondary hyperparathyroidism (SHPT) on renal anemia in maintenance hemodialysis patients. Methods 34 cases of maintenance hemodialysis patients with active vitamin D3 or parathyroidectomy correct SHPT, according to the treatment effect is divided into group 1 [after treatment of the whole parathyroid hormone (immunoreactive parathyroidism hormone, iPTH ≥ 350 ng / ml] And group 2 (iPTH <350 ng / ml after treatment). The changes of hemoglobin (Hb), hematocrit (Hct), recombinant human erythropoietin (r-HuEPO) dosage to Hct, EPO / Hct before and after treatment were observed. Results Of the 34 patients, iPTH was reduced to below 350 ng / ml in 25 patients (group 2), and iPTH in 9 patients was significantly higher than 350 ng / ml (group 1). The parameters of group 1 and group 2 before treatment were not statistically different. After treatment, the parameters Hb, Hct and EPO / Hct in group 2 were higher than those in group 1, and the difference was statistically significant. In group 2, the serum iPTH decreased from (739.03 ± 411.77) pg / ml to (251.91 ± 72.9) pg / ml, and the Hb increased from (104.32 ± 9.56) g / L to (116.44 ± 7.37) g / (P <0.05). The mean value of EPO / Hct decreased from (4.36 ± 1.46) × 104 U to (3.47 ± 1.10) × 104 U, P <0.05) Hb (107 ± 11.41) g / L, Hct (33.3 ± 3.5)%, EPO / Hct value (4.36 ± 1.46) × 104U and post-treatment iPTH (1029.3 ± 281.041) pg / ± 11.12) g / L, Hct (32.8 ± 3.3)%, EPO / Hct (5.13 ± 1.74) × 104U, all P> 0.05. Conclusion SHPT is an important factor that causes EPO resistance. Correcting SHPT in maintenance hemodialysis patients is helpful to correct renal anemia.