慢性肾衰甲旁亢对红细胞生成素疗效的影响

摘要

Objective:To explore the effect of erythropoietin(EPO)on patients of chronic renal failure with hyperparathyroidism.Methods:40 cases of chronic renal failure with hyperparathyroidism were involved in this study,among them 20 cases were administered orally with 1,25 dihydroxy cholecalciferol at a dosage of 1.75-4 μg/week and EPO 3000 u S.C.twice a week(treatment group) and 20 cases were given EPO 3000 u S.C.twice a week alone(patient control group).Comparison was made between the two groups in clinical manifestations of hyperparathyroidism,Hb,HCT and serum PTH,ALP,P and Ca were observed.Results:In treatment group,levels of PTH and S-P significantly decreased(P<0.01),Hb,HCT and S-Ca significantly increased(P<0.01) and a better improvement in clinical manifestationa at the end of 10 weeks of treatment.In patient control group,no significantly difference of the level of Hb,HCT and PTH etc was found before and after treatment.Conclusion:Pulse therapy with low dose oral 1,25 dihydroxy cholecalciferol is effective in the treatment of renal failure with secondary hyperparathyroidism.Secondary hyperparathyroidism is one of the causes for resistance to EPO.%目的：了解慢性肾功能衰竭继发性甲状旁腺功能亢进症(简称慢性肾衰继发性甲旁亢)患者对红细胞生成素(EPO)疗效的影响。方法：选择慢性肾衰继发性甲旁亢患者40 例，随机分成2组。Ⅰ组口服1，25二羟胆骨化醇1.75 μg/周～4 μg/周，同时给予EPO 3 000 u皮下注射，2次/周。Ⅱ组单用EPO 3 000 u皮下注射，2次/周，均观察10周。结果：Ⅰ组患者治疗后血甲状旁腺激素、血红蛋白、红细胞压积、血磷、血钙与治疗前相比，差异显著(P<0.01)。Ⅱ组各项指标治疗后与治疗前相比，差异不显著。结论：大剂量1，25二羟胆骨化醇治疗慢性肾衰继发性甲旁亢十分有效，慢性肾衰患者甲状旁腺激素继发性升高是EPO治疗拮抗的一个重要原因。使用EPO治疗肾性贫血前，应常规进行甲状旁腺功能检查，并对甲旁亢予以纠正，以提高EPO治疗效果。