还原型谷胱甘肽联合重组人促红细胞生成素治疗尿毒症贫血患者的临床疗效观察

摘要

目的：观察还原型谷胱甘肽联合重组人促红细胞生成素治疗尿毒症贫血患者的临床疗效。方法将72例患者按随机数字表法分为还原型谷胱甘肽联合重组人促红细胞生成素治疗组（治疗组）和单用重组人促红细胞生成素治疗组（对照组），每组36例。两组患者均给予规律血液透析3次/周，4h/次，在常规用药基础上（口服铁剂、叶酸、甲钴胺等），均使用重组人促红细胞生成素注射液，治疗量为每周100～150U/kg。治疗组在上述治疗方案上给予还原型谷胱甘肽针1.2g，加入0.9%氯化钠注射液100ml中，静脉滴注，3次/周（透析后用）。两组疗程均为8周。治疗后比较两组临床疗效、RBC、Hb、红细胞压积（HCT）、血清铁蛋白（SF）、超氧化物岐化酶（SOD）、血浆丙二醛（MDA）、谷胱甘肽过氧化物酶（GSHPx）、C反应蛋白（CRP）、肱三头肌皮褶厚度（TSF）、BMI、腰臀比、钙（Ca2+）、钾（K+）、钠（Na+）改善情况，并观察不良反应情况。结果两组经治疗后，其中治疗组总有效32例，总有效率88.89%，对照组总有效26例，总有效率72.22%，差异有统计学意义（P＜0.05）；治疗组患者Hb、RBC、HCT、SF贫血指标水平升高比对照组更明显（P＜0.05）；治疗组患者SOD、GSHPx水平与对照组比较升高更明显，MDA、CRP水平下降更明显（P＜0.05），治疗组患者BMI与对照组比较升高更明显（P＜0.05）；两组治疗前后腰臀比、TSF、Ca2+、K+、Na+差异均无统计学意义（均P＞0.05）两组均未见严重不良反应。结论还原型谷胱甘肽联合重组人促红细胞生成素治疗尿毒症贫血，临床疗效确切，症状及生化指标改善明显，不良反应少，且费用相对低廉，值得在临床推广应用。%Objective To assess the clinical effects of reduced glutathione combined with erythropoietin in treatment of anemia in patients with uremia. Methods Seventy two patients were randomly divided into study group and control group with 36 cases in each group. Patients in both groups underwent hemodialysis 3/wk, received conventional medication (oral iron, folic acid, methylcobalamin) and recombinant human erythropoietin injection (EPO) 100~ 150U/kg/wk. If Hb reached 130g/L, EPO dose was reduced by 25%. Patients in study group were given additional reduced glutathione 1.2g, ivgtt, 3/wk. The duration of treatment was 8 weeks in both groups. The RBC, Hb, HCT, SF, SOD, MDA, GSHPx, CRP, TSF, BMI, WHR, Ca2+, K+, Na+were measured before and after treatment. The adverse reactions were observed. Results The overal efficacy rate in study group was high than control group (88.9%, 72.2%, P<0.05). The Hb, RBC, HCT and SOD, GSHPx levels in study group were increased more markedly, than those in control group(P<0.05);while the level of MDA decreased significantly(P<0.05). There were no severe adverse reactions in two groups. Conclusion Reduced glutathione combined with erythropoietin can increase clinical curative rate, improve the symptoms and biochemical indexes in patients with uremic anemia without severe adverse re-actions.