甲状旁腺功能亢进对血液透析患者炎症状态及重组人促红细胞生成素需求的额外影响。

Additional effect of hyperparathyroidism on inflammatory status and rHuEPO requirements in hemodialysis patients.

作者信息

Tutal E, Sezer S, Afsar B, Arat Z, Ozdemir F N, Haberal M

机构信息

Department of Nephrology, Baskent University Hospital, Ankara, Turkey.

出版信息

Transplant Proc. 2006 Nov;38(9):2807-12. doi: 10.1016/j.transproceed.2006.08.104.

DOI:10.1016/j.transproceed.2006.08.104

PMID:17112835

Abstract

BACKGROUND

The aim of this study was to analyze the effects of elevated parathyroid hormone (iPTH) and C-reactive protein (CRP) on rHuEPO requirements and associated clinical and biochemical parameters of hemodialysis patients.

METHODS

A total of 127 hemodialysis patients were included. Laboratory values from the previous 3 months (monthly measured CRP, iPTH, albumin, prealbumin, calcium, phosphorus, and hemoglobin) and clinical findings (rHuEPO requirements, iron supplements, Kt/V) were recorded retrospectively. Patients were subgrouped according to presence of hyperparathyroidism (mean iPTH > 350 pg/mL) and chronic inflammation (mean CRP > 8.5 mg/L) as group I (low iPTH, low CRP, n = 32), group II (high iPTH, low CRP, n = 32), group III (low iPTH, high CRP, n = 32), and group IV (high iPTH, high CRP, n = 31).

RESULTS

We found that group IV had lowest hemoglobin (P < .0001, .0001, .01, respectively), albumin (P < .0001), prealbumin (P < .0001, .0001, .02, respectively), and highest rHuEPO requirements (P < .0001, .0001, .01, respectively) compared to other groups despite of similar iron indices. Group III also had lower albumin (P < .002, .0001, respectively), prealbumin (P < .001, .01, respectively), hemoglobin (P < .001, .005, respectively), but higher rHuEPO requirements (P < .01) compared to group I and group II.

CONCLUSIONS

We propose that hyperparathyroidism increases rHuEPO requirements and aggravates the negative effects of chronic inflammation in hemodialysis patients.

摘要

背景

本研究旨在分析甲状旁腺激素（iPTH）升高和C反应蛋白（CRP）对血液透析患者促红细胞生成素（rHuEPO）需求量以及相关临床和生化参数的影响。

方法

共纳入127例血液透析患者。回顾性记录前3个月的实验室检查值（每月测定的CRP、iPTH、白蛋白、前白蛋白、钙、磷和血红蛋白）以及临床检查结果（rHuEPO需求量、铁剂补充量、Kt/V）。根据是否存在甲状旁腺功能亢进（平均iPTH>350 pg/mL）和慢性炎症（平均CRP>8.5 mg/L）将患者分为四组：I组（低iPTH、低CRP，n = 32）、II组（高iPTH、低CRP，n = 32）、III组（低iPTH、高CRP，n = 32）和IV组（高iPTH、高CRP，n = 31）。

结果

我们发现，尽管铁指标相似，但与其他组相比，IV组的血红蛋白水平最低（P分别<0.0001、0.0001、0.01），白蛋白水平最低（P<0.0001），前白蛋白水平最低（P分别<0.0001、0.0001、0.02），rHuEPO需求量最高（P分别<0.0001、0.0001、0.01）。与I组和II组相比，III组的白蛋白水平也较低（P分别<0.002、0.0001），前白蛋白水平较低（P分别<0.001、0.01），血红蛋白水平较低（P分别<0.001、0.005），但rHuEPO需求量较高（P<0.01）。