Influence of Blood Purification Modality on the Efficacy of Erythropoietin in Patients on Maintenance Hemodialysis_West China Medical Journal

Authors：

Nephrology Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

Keywords：

血液灌流; 血液透析滤过; 肾性贫血; 促红细胞生成素; 炎症介质

DOI：

10.7507/1002-0179.20130210

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目的　通过比较三种血液净化方式对炎症介质、甲状旁腺激素等中大分子毒素的清除效果，并观察促红细胞生成素（EPO）的治疗效果，探寻有利于肾性贫血改善的最佳透析模式。方法　 2011年5月－8月采用前瞻性、随机对照、开放式设计，选择维持性血透患者60例，随机分成3组，每组20例。血液灌流（HDP）组[每2周5次血液透析（HD）+1次HDP]、血液透析滤过治疗（HDF）组（每2周5次HD+1次HDF）、HD组（每2周6次HD），随访3个月。检测试验前后反应蛋白（CRP）、β2微球蛋白、甲状旁腺素（PTH）、白介素-6的水平以及各组患者肾性贫血指标的变化。结果　3个月试验结束时，HDP组和HDF组4项尿毒症毒素水平均显著下降，其中HDP组CRP水平明显低于HDF组（P＜0.05）；HDP组和HDF组试验后的血红蛋白水平较试验前升高，ERI值下降。HD组试验前后的毒素水平无明显变化，ERI值升高。3组患者均未出现严重不良事件。结论　HDP和HDF清除中大分子毒素的能力优于HD，有利于缓解微炎症状态，改善EPO治疗效果。HDP和HDF的远期效果哪种更好，尚有待于进一步的研究。

Citation： CHEN Xiaolei,ZHENG Haotian,ZHU Yalin,FU Ping.. Influence of Blood Purification Modality on the Efficacy of Erythropoietin in Patients on Maintenance Hemodialysis. West China Medical Journal, 2013, 28(5): 660-663. doi: 10.7507/1002-0179.20130210 Copy

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4.	Jeong KH, Lee TW, Ihm CG, et al. Polymorphisms in two genes, IL-1B and ACE, are associated with erythropoietin resistance in Korean patients on maintenance hemodialysis[J]. Exp Mol Med, 2008, 40(2): 161-166.
5.	Kalantar-Zadeh K, Lee GH, Miller JE, et al. Predictors of hyporesponsiveness to erythropoiesis-stimulating agents in hemodialysis patients[J]. Am J Kidney Dis, 2009, 53(5): 823-834.
6.	龚德华. 血液透析滤过技术的一些进展[J].肾脏病与透析肾移植移植杂志, 2004, 13(2): 184-187.
7.	Winchester JF, Harbord NB. Intoxications amenable to extracorporeal removal[J]. Adv Chronic Kidney Dis, 2011, 18(3): 167-171.
8.	Stegmayr B, Ramlow W, Balogun RA. Beyond dialysis: current and emerging blood purification techniques[J]. Semin Dial, 2012, 25(2): 207-213.
9.	秦健, 刘萍, 刘金彦, 等. 高通量血液透析和血液灌流联合血液透析对维持血透患者微炎症状态的影响[J]. 临床内科杂志, 2010, 27(6): 425-426.
10.	陈舜杰, 陆玮, 季刚, 等. 维持性血液透析联合血液灌流: 一种安全有效的模式[J]. 中华肾脏病杂志, 2011, 27(1): 7-11.
11.	宋发超. 血液灌流在透析患者肾性贫血治疗中的作用及影响因素[J]. 重庆医学, 2012, 41(17): 1753-1755.
12.	秦健, 关中宪, 刘金彦, 等. 血液灌流联合血液透析对维持血透患者微炎症状态的影响[J]. 中国中西医结合肾病杂志, 2008, 9(12): 1099-1100.

1. 　López-Gómez JM, Portolés JM, Aljama P. Factors that condition the response to erythropoietin in patients on hemodialysis and their relation to mortality[J]. Kidney Int Suppl, 2008, 111: 75-81.
2. 　陈香美, 初启江. 不同血液净化方式对蛋白结合类毒素的清除作用[J]. 中国血液净化, 2005, 4(11): 581-584.
3. 　Locatelli F, Canaud B, Eckardt KU, et al. Oxidative stress in end-stage renal disease: an emerging threat to patient outcome[J]. Nephrol Dial Transplant , 2003, 18(7): 1272-1280.
4. 　Jeong KH, Lee TW, Ihm CG, et al. Polymorphisms in two genes, IL-1B and ACE, are associated with erythropoietin resistance in Korean patients on maintenance hemodialysis[J]. Exp Mol Med, 2008, 40(2): 161-166.
5. 　Kalantar-Zadeh K, Lee GH, Miller JE, et al. Predictors of hyporesponsiveness to erythropoiesis-stimulating agents in hemodialysis patients[J]. Am J Kidney Dis, 2009, 53(5): 823-834.
6. 　龚德华. 血液透析滤过技术的一些进展[J].肾脏病与透析肾移植移植杂志, 2004, 13(2): 184-187.
7. 　Winchester JF, Harbord NB. Intoxications amenable to extracorporeal removal[J]. Adv Chronic Kidney Dis, 2011, 18(3): 167-171.
8. 　Stegmayr B, Ramlow W, Balogun RA. Beyond dialysis: current and emerging blood purification techniques[J]. Semin Dial, 2012, 25(2): 207-213.
9. 　秦健, 刘萍, 刘金彦, 等. 高通量血液透析和血液灌流联合血液透析对维持血透患者微炎症状态的影响[J]. 临床内科杂志, 2010, 27(6): 425-426.
10. 　陈舜杰, 陆玮, 季刚, 等. 维持性血液透析联合血液灌流: 一种安全有效的模式[J]. 中华肾脏病杂志, 2011, 27(1): 7-11.
11. 　宋发超. 血液灌流在透析患者肾性贫血治疗中的作用及影响因素[J]. 重庆医学, 2012, 41(17): 1753-1755.
12. 　秦健, 关中宪, 刘金彦, 等. 血液灌流联合血液透析对维持血透患者微炎症状态的影响[J]. 中国中西医结合肾病杂志, 2008, 9(12): 1099-1100.

West China Medical Journal

Influence of Blood Purification Modality on the Efficacy of Erythropoietin in Patients on Maintenance Hemodialysis

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