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不同治疗方式对改善尿毒症继发甲状旁腺功能亢进症维持性血液透析患者肾性贫血的影响

Effects of different treatment methods on renal anemia in maintenance hemodialysis patients with hyperparathyroidism secondary to uremia

摘要:

目的 比较3种治疗方式对改善尿毒症继发甲状旁腺功能亢进症(SHPT)维持性血液透析患者肾性贫血的疗效,分析影响红细胞生成素(EPO)用量的因素.方法 回顾性收集2015年1月至2016年12月在复旦大学附属华山医院血液透析中心接受治疗的尿毒症SHPT 55例患者的临床资料.根据治疗方式不同分为3组:甲状旁腺切除+前臂移植术组(手术组,n=16)、西那卡塞治疗组(n=6)和骨化三醇治疗组(n=33).分别于治疗前及治疗后3个月、6个月、12个月检测患者血红蛋白水平及EPO用量,观察治疗前后3组患者的血红蛋白变化值及EPO用量变化值随时间变化的趋势.采用混合效应模型分析3组间血红蛋白水平及EPO用量变化值的差异.采用多元线性回归分析1年后EPO使用指数的影响因素.结果 手术组及西那卡塞组患者治疗前血全段甲状旁腺素(iPTH)水平显著高于骨化三醇组,治疗后第12个月手术组及西那卡塞组患者血iPTH水平较治疗前组明显下降,且手术组血碱性磷酸酶、血钙、血磷水平较术前水平明显下降(均P﹤0.05).混合效应模型分析结果显示,手术组术后血红蛋白呈上升趋势,其血红蛋白变化值增加水平高于其他两组(P=0.007).3组患者EPO用量变化值的差异无统计学意义.组内比较显示,手术组患者随访第12个月EPO用量较术前明显降低(P=0.007).多因素回归分析结果显示,透析龄(B=-0.064,P=0.012)、铁蛋白(≥500μg/L相对于<200μg/L,B=0.645,P=0.032)是EPO用量的独立影响因素,透析龄越大,EPO用量越少;铁蛋白≥500μg/L的患者EPO用量明显较多.结论 甲状旁腺切除+前臂移植术治疗能有效地降低患者术后EPO用量,改善肾性贫血.透析龄、铁蛋白是EPO用量的独立影响因素.

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abstracts:

Objective To observe the effects of three treatment methods on renal anemia in maintenance hemodialysis patients with hyperparathyroidism secondary to uremia and analyze the influencing factors of erythropoietin (EPO) dosage. Methods A total of 55 maintenance hemodialysis patients with secondary hyperparathyroidism at the hemodialysis center of Huashan Hospital affiliated to Fudan University from January 2015 to December 2016 were retrospectively divided into three groups according to different treatment methods, parathyroidectomy +forearm transplantation group (surgery group, n=16), cinacalcet treatment group (n=6), and calcitriol treatment group (n=33), respectively. The hemoglobin level and erythropoietin dosage were measured before treatment and in the 3rd month, the 6th month and the 12th month after treatment. The changes of hemoglobin and erythropoietin dosage in the three groups before and after treatment were observed, and the mixed effect model was used to analyze the difference of the change of hemoglobin and erythropoietin dosage among three groups. Multiple linear regression analysis was used to analyze the influencing factors of EPO dosage after one year. Results The levels of intact parathyroid hormone (iPTH) in the surgery group and the cinacalcet group before treatment were significantly higher than that in the calcitriol group (both P<0.05). In the 12th month after treatment, the levels of iPTH decreased significantly in the patients of surgery group and the cinacalcet group compared with those before treatment (both P<0.05). The levels of serum alkaline phosphatase, serum calcium and serum phosphorus in the surgery group also decreased significantly compared with those before treatment (all P<0.05). The mixed effect model analysis showed that the hemoglobin level of surgery group was on an upward trend after the treatment, and the overall level was significantly higher than cinacalcet and calcitriol treatment group (P=0.007). There was no significant difference in the dosage change of erythropoietin (EPO) in the three groups over time. However, the intra-group comparison of the mixed effect model showed that the dosage of EPO in the 12th month was significantly lower than that of before the treatment in surgery group (P=0.007). Multiple linear regression analysis showed that dialysis vintage (B=-0.064, P=0.012) and ferritin ≥ 500 μg/L (B=0.645, P=0.032) were independent influencing factors of EPO dosage. The longer the dialysis vintage, the less EPO dosage, and more EPO dosage were observed in patients with ferritin ≥ 500 μg/L. Conclusions Parathyroidectomy and forearm transplantation is more effective in reducing EPO dosage and improving renal anemia in maintenance hemodialysis patients with secondary hyperparathyroidism. Dialysis vintage and ferritin are independent influencing factors for the dosage of EPO.

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作者: 王梦婧 [1] 黄碧红 [1] 陶冶 [1] 张炜晨 [1] 陈伟生 [1] 黄骏文 [2] 王红鹰 [2] 张敏敏 [1] 陈靖 [1]
期刊: 《中华肾脏病杂志》2018年34卷12期 909-916页 ISTICPKUCSCD
栏目名称: 临床研究
DOI: 10.3760/cma.j.issn.1001-7097.2018.12.005
发布时间: 2019-01-07
基金项目:
国家自然科学基金 上海市自然科学基金 上海市科学技术委员会基金 上海市科委创新行动计划项目(17411950700)National Natural Science Foundation of China Shanghai Natural Science Foundation Shanghai Science and Technology Commission Fund Shanghai Science and Technology Commission Fund
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