维持性血液透析患者应用维生素C对促红细胞生成素疗效的影响

摘要

目的 观察维生素C联合促红细胞生成素(EPO)治疗维持性血液透析(MHD)患者肾性贫血的疗效.方法 将60例MHD病例随机分为对照组及观察组各30例,对照组采用EPO治疗,观察组采用EPO联合维生素C治疗;比较2组治疗前及治疗6个月后微炎性反应指标(CRP、IL-6、TNF-α)、氧化应激反应指标(MDA)及贫血指标(SF、Hb、Hct、RBC)的变化.结果 对照组治疗前后CRP、IL-6、TNF-α、MDA均无显著改善(P﹥0.05),Hb、Hct、RBC得到一定程度改善(P<0.05,P<0.01),而观察组CRP、IL-6、MDA、Hb、Hct、RBC均较治疗前明显下降(P<0.05,P<0.01),且CRP、IL-6、Hb、Hct较对照组改善更显著(P<0.05,P<0.01).结论 MHD患者微炎性反应状态是影响EPO疗效的重要因素,而维生素C可一定程度上改善微炎性反应状态,从而提高EPO疗效,可作为治疗肾性贫血的辅助药物常规应用.%Objective To observe the combined vitamin C and erythropoietin ( EPO ) treatment of micro inflammatory state of renal anemia. Methods 60 patients undergoing maintenance hemodialysis ( MHD ) were randomly divided into control group and observation group ( 30 patients in each group ). In the control group, patients were treated with EPO for treating renal anemia. In the observation group, EPO and vitamin C were used for treating renal anemia; before and 6 months after treatment, micro inflammatory state, oxidative stress and anemia and other indicators were recorded and analyzed. Results In the control group, before and after treatment, inflammatory mediators, oxidative stress index did not change significantly( P > 0.05 ), anemia( Hb,Hct,RBC ) has been improved in some extent( P <0.05, P <0.01 ); compared with before treatment, inflammatory mediators, oxidative stress index was significantly decreased the in the observation group after treatment( P < 0.05, P <0.01 ), while anemia improved more significantly than in the control group( P < 0. 05, P < 0. 01 ), after treatment, Hb, Hct and other indicators of anemia was statistically significant difference between observation and control group ( P < 0. 05, P < 0. 01 ). Conclusion Micro inflammatory state affect the efficacy of EPO in patients with MHD. Vitamin C can be used to improve the micro inflammatory state; thereby enhancing the efficacy of EPO. Vitamin C can be used as auxiliary treatment for renal anemia.