不同剂量rHuEPO对维持性血液透析患者肾性贫血的改善作用

摘要

目的:观察大剂量重组人促红细胞生成素(rHuEPO)对维持性血液透析(MHD)患者肾性贫血的改善作用.方法:60例MHD患者随机分为3组:对照组(n=20):给予益比奥3000IU/次,静脉注射,3次/周.治疗1组(n=20):益比奥1万IU/周,1次静脉注射.治疗2组(n=20):益比奥1万IU/周,1次静脉注射,在血红蛋白上升至100g/L以后,改为3000IU/次,静脉注射,1次/周维持.总疗程6月.观察患者对透析的耐受以及血红蛋白(Hb)、红细胞压积(Hct)、血浆蛋白(TP)及血脂、肝、肾功能的改善情况.结果:治疗1组和2组在1个月时Hb、Hct即开始明显上升,1～3月上升幅度明显,4～6月上升减慢;同时患者精神状态明显好转;治疗结束时血浆总蛋白、白蛋白、转铁蛋白浓度均较前增加,肝功、肾功及血脂无显著性变化.但后期治疗1组患者血压有升高趋势.结论:大剂量rHuEPO应用可以快速纠正MHD肾性贫血,但血红蛋白上升至100g/L时建议改为3000 IU/周维持,减少医疗费用的同时可降低副反应.%Objective: To observe the clinical effects of high dose of recombinant human erythropoietin (H-rHuEPO) on the improvement of uremicanemia by intravenous injection once a week in the maintenance heamodialysis (MHD) patients. Methods: Sixty patients aged (63. 4±7. 5) years who were undergoing MHDwere randomly assigned into control group accepted 3000IU of rHuEPO through intravenous injection twice or 3 times a week, and to treatment group 1 with intravenous infusion of 10000IU of rHuEPO and to treatment group 2 treated as same as group 1,but 3000IU of rHuEPO through intravenous injection once a week when Hb＞100g/L after each hemodialysis, 6 months as a course. The tolerance to hemodialysis and side effects were observed, and meanwhile blood routine and biochemical examinations were performed in all patients. Results : After 6-month treatment, no significantly difference was found in the lipometabolism, liver function, kidney function with three groups; But hemoglobin, Hct values, albumin and transferrin were significantly improved in treatment group 1 and 2,especially hemoglobin and Hct were markly increased at 1～3 months than at 4～6 months. But it appeared the prevalence of hypertension at the later stage of treatment.Conclusion: H-rHuEPO is a better way to improve uremic anemia of MHD patients. But when Hb≥100g/L or Hct≥30％ ,the dosage should be decreased to 3000 IU/w in order to reduce the side effects and medical cost,at same time to improve the compliance of patients.