中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (11): 672-675.doi: 10.3969/j.issn.1671-4091.2015.11.008

• 临床研究 • 上一篇    下一篇

骨化三醇对维持性血液透析患者微炎症及贫血的影响

李欣1,贾强2   

  1. 1. 北京积水潭医院肾内科
    2. 首都医科大学宣武医院肾内科
  • 收稿日期:2015-06-24 修回日期:2015-07-17 出版日期:2015-11-12 发布日期:2015-11-12
  • 通讯作者: 贾强 ：jiaqiang9509@sina.com.cn E-mail:jiaqiang9509@sina.com.cn

Effects of calcitriol supplement on mico- inflammation and anemia in maintenance hemodialysis patients

  • Received:2015-06-24 Revised:2015-07-17 Online:2015-11-12 Published:2015-11-12

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摘要： 【摘要】目的对维持性血液透析(maintenance hemodialysis,MHD)人群维生素D 不足和缺乏的发生率进行调查，探索应用活性维生素D 对于MHD 患者能否改善微炎症反应、增加红细胞生成素的反应性，改善贫血。方法对于首都医科大学附属宣武医院血液净化中心规律透析的患者进行血清25(OH)D3测定，选取测定结果≤30ng/ml 的患者为研究对象，将符合入组标准的患者共74 例随机分成2 组，试验组和对照组各37 例，每组患者在年龄、性别构成比例、透析龄、原发病及实验室指标无差异。试验组每日睡前口服骨化三醇0.25ug QN，对照组口服安慰剂，共12 周。检测每组患者治疗前及治疗后12 周的血红蛋白(hemoglobin,Hb)、红细胞生成素(erythropoietin,EPO)的用量、超敏C 反应蛋白(high-sensitivity Creactionprotein,hs-CRP)及25 羟基维生素D3水平[25-Hydroxyvitamin D3,25(OH)D3]。结果①试验组用药前后自身对比：试验组的HGB 较用药前明显升高[(117.25±10.94)g/L vs. (122.72±11.16)g/L, P＜0.05]，hs- CRP 水平较用药前明显下降[(4.38 ± 4.15)mg/L vs. (2.92 ± 1.77)mg/L, P＜0.05]；EPO[(8083.33±4223.24) IU/W vs. (7694.44±3615.10)IU/W,P＞0.05]用量较用药前有所下降，但差异无统计学意义。②试验组和对照组用药后各项指标的对比：试验组的HGB 高于对照组[(122.72±11.16)g/L vs. (118.53±9.56)g/L,P＞0.05]，EPO 用量低于对照组[(7694.44±3615.10)
IU/W vs. (8666.67±4708.66)IU/W,P＞0.05]，但差异无统计学意义；试验组的hs-CRP 水平明显低于对照组[(2.92±1.77)mg/L vs. (4.48±3.93)mg/L,P＜0.05]，差异有统计学意义。结论骨化三醇可以改善MHD患者的微炎症反应，增加红细胞生成素的反应性，减少EPO 的用量，改善贫血。

关键词: 微炎症状态, 贫血, 活性维生素D, 维持性血液透析

Abstract: 【Abstract】Objective To investigate the prevalence of vitamin D deficiency in patients on maintenance hemodialysis (MHD) and to explore the effects of active vitamin D preparation on micro-inflammation, erythropoietin responsiveness and anemia. Methods We assayed serum 25-hydroxyvitamin D3 (25(OH)D3) level in MHD patients treated in our dialysis center, and then investigated the MHD patients with serum 25(OH) D3 ≤30 ng/ml. Seventy- four patients fulfilled the inclusion criteria, and were randomly divided into two groups: the treatment group (calcitriol 0.25μg every night for 12 weeks; n=37) and the control group (placebo for 12 weeks; n=37). Age, sex ratio, MHD duration, primary renal disease and laboratory parameters were comparable between the two groups. Blood hemoglobin (HGB), dose of erythropoietin (EPO), high-sensitivity C-reaction protein (hs-CRP) and 25(OH)D3 level were measured before and after the treatment. Results ① In the treatment group after the treatment for 12 weeks, HGB increased from 117.25±10.94 g/L to 122.72± 11.16 g/L (P＜0.05), hs-CRP decreased from 4.38±4.15mg/L to 2.92±1.77mg/L (P＜0.05), and EPO dose also decreased but without statistical significance. ② After the treatment for 12 weeks, hs-CRP was significantly lower in the treatment group than in the control group (2.92±1.77mg/L vs. 4.48±3.93mg/L, P＜0.05). HGB was higher in the treatment group than in the control group and EPO dose reduced more in the treatment group than in the control group but without statistical significances (for HGB, 122.72 ±11.16 g/L vs. 118.53± 9.56 g/L, P＞0.05; for EPO dose, 7694.44±3615.10 IU/w vs. 8666.67±4708.66 IU/w, P＞0.05). Conclusions Supplement of calcitriol can improve micro-inflammation, anemia, and EPO responsiveness in MHD patients.

Key words: micro-inflammation, anemia, 25-Hydroxyvitamin D3, maintenance hemodialysis