目的 对微炎症状态下重组人红细胞生成素(recombinant human erythropoietin,r-HuEPO)治疗维持性血液透析(maintain hemodialysis,MHD)患者肾性贫血的疗效进行分析，探讨影响r-HuEPO疗效的相关因素。方法 根据血清高敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)的数值，将54例MHD患者分为2组：微炎症组(hs-CRP＞5 mg/L)和非微炎症组(hs-CRP≤5 mg/L)，测定血红蛋白(hemoglobin,Hb)、血细胞比容(hematocrit,Hct)、hs-CRP、白细胞介素6(interleukin-6,IL-6)、血清铁蛋白(serum ferritin,SF)、血清白蛋白(albumin,Alb)、血清肌酐(serum creatinine,SCr)和全段甲状旁腺激素(intact parathyroid hormone,iPTH)的水平，计算各指标均值，并比较两组间的差异；以r-HuEPO的用量[IU/(Kg•周)]与Hct的比值(EPO/Hct)作为EPO反应性的指标，对影响EPO反应性的指标进行多因素分析。结果 54例MHD患者中，29例(53.7%)hs-CRP升高(微炎症组)，25例(46.3%)正常(非微炎症组)，微炎症组的hs-CRP、IL-6和EPO/Hct比值水平均显著高于非微炎症组(P＜0.01)，Hb和Hct显著低于非微炎症组(P＞0.05)；单因素相关性分析显示EPO反应性(EPO/Hct)与hs-CRP、IL-6和iPTH呈正相关，与Alb呈负相关；多因素逐步线性回归分析显示，hs-CRP升高是影响EPO反应性的独立危险因素。结论 微炎症状态是影响MHD 患者r-HuEPO疗效的重要因素。
Objective To observe the effects of recombinant human erythropoietin (r-HuEPO) therapy on renal anemia, and to investigate the factors relating to the effects of r-HuEPO in maintenance hemodialysis patients. Methods Based on the serum high sensitivity C-reactive protein (Hs-CRP) level, 54 maintenance hemodialysis patients were divided into microinflammation group (Hs-CRP>5mg/L) and non-microinflammation group (Hs-CRP<5mg/L). Their hemoglobin (Hb), hematocrit (Hct), and serum Hs-CRP, interleukin-6 (IL-6), ferritin (SF), albumin (Alb), creatinine (SCr) and immunoreactive parathyroid hormone (iPTH) were measured. The ratio of r-HuEPO IU/kg/week to Hct (EPO/Hct) was used as the parameter for the responsiveness to r-HuEPO. Results Patients in the microinflammation group (29 cases, 53.7%) showed higher IL-6 and EPO/Hct ratio, but lower Hb and Hct, as compared with those in the non-microinflammation group (25 cases, 46.3%). Simple correlation analysis found that Hs-CRP, IL-6, iPTH and Alb were associated with the EPO/Hct ratio. Multiple stepwise regression analysis indicated that increased Hs-CRP was the independent risk factor on responsiveness to r-HuEPO. Conclusion Microinflammation status is one of the complications in maintenance hemodialysis patients. High level of Hs-CRP is an important factor causing hypo-responsiveness to r-HuEPO.
