中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (08): 566-569.doi: 10.3969/j.issn.1671-4091.2014.08.004

• 临床研究 • 上一篇    下一篇

中心静脉半永久置管对维持性血透患者促红细胞生成素治疗的影响

陈凤锟,李冀军,赵长征   

  1. 解放军总医院第一附属医院肾内科
  • 收稿日期:2014-04-15 修回日期:2014-05-24 出版日期:2014-08-12 发布日期:2014-08-12
  • 通讯作者: 李冀军 lijj9536@sina.com E-mail:lijj9536@sina.com

The effect of tunneled central venous catheter on erythropoietin therapy in maintenance hemodialysis patients

  • Received:2014-04-15 Revised:2014-05-24 Online:2014-08-12 Published:2014-08-12

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摘要： 【摘要】　目的　有研究提示维持性血液透析（MHD）患者使用中心静脉置管相对于内瘘存在更重的炎症状态，而炎症又是加重肾性贫血的重要原因。本研究试图通过比较不同血管通路患者的贫血相关指标，了解通路对肾性贫血治疗产生的影响。　方法　采用回顾性的配对设计。选取2012年4月至2013年3月间在我院血液净化中心持续接受治疗的患者，根据血管通路不同分为半永久置管组和内瘘组，按照性别、年龄、原发病、透析龄及通路使用时间共配成14例对子。记录其在观察期内血红蛋白（Hb）、促红细胞生成素（EPO）用量及超敏C反应蛋白（SCRP）等指标，比较组间差异。　结果　两组患者基线资料匹配较好（P>0.05）。观察期内两组Hb水平无差异（P=0.210），但半永久置管组EPO的月平均用量高于内瘘组（691.022±141.763 vs. 533.198±174.558U/Kg/月，P=0.014）。对两组白细胞计数（WBC）、SCRP等指标的比较没有发现差异（P>0.05），而半永久置管组通路感染住院次数和天数高于内瘘组（P=0.034，0.035）。　结论　为维持大致相同的Hb水平，比较使用内瘘的MHD患者，半永久置管患者需要注射更大剂量的EPO，故血管通路与肾性贫血的EPO治疗可能存在联系。本研究对其原因尚不能提出明确答案，需要今后扩大样本并进行更严格的前瞻性研究。

关键词: 中心静脉置管, 动静脉内瘘\贫血, 促红细胞生成素

Abstract: 【Abstract】Objective Recent studies have suggested that maintenance hemodialysis (MHD) patients with central venous catheter have heavier inflammatory state than those with arteriovenous fistula (AVF), and that inflammation is an important factor leading to aggravated renal anemia. The present study aimed to understand the effect of different vascular accesses on the therapy of renal anemia through comparing anemia-related indicators. Methods This was a retrospective paired-designed study. The individuals who received treatment in our blood purification center from April 2012 to March 2013 were selected and divided into groups of tunneled catheter (TC) and AVF according to the vascular access. Then, fourteen pairs were matched for gender, age, primary disease, duration of dialysis, and usage time of access. During observation period, the indicators such as hemoglobin (Hb), dose of erythropoietin (EPO), and high-sensitivity C-reactive protein (SCRP) etc. were recorded for comparing differences between the groups. Results The baseline data of the two groups were well matched (P＞0.05). During observation period, there was no difference between their Hb levels (P=0.210), but the average monthly EPO dose of TC group was higher than that of AVF group (691.022±141.763 vs. 533.198±174.558 IU/(kg•month), P =0.014). There was also no difference between the two groups in their count of white blood cell (WBC), SCRP and most of the other indicators (P＞0.05), while the frequency and duration of hospitalization due to access infection in TC group were more than those in AVF group (P =0.034, 0.035). Conclusion I In order to maintain similar Hb level, MHD patients with TC need to inject higher doses of EPO than those with AVF, therefore, vascular access could be associated with EPO therapy for renal anemia. However, no definite answer could be derived from present study, and larger sample and more strictly designed prospective researches will be needed in the future

Key words: Central venous catheters, Arteriovenous fistula, Anemia, Erythropoietin