中国血液净化

›› 2006, Vol. 5 ›› Issue (9): 671-674.

• 论著 • 上一篇    下一篇

维持性血液透析患者血红蛋白水平分析及相关因素探讨

俞 勇 邬碧波 张黎明

  

  1. 200070 上海，上海市闸北区中心医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2006-09-12 发布日期:2006-09-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2006-09-12 Published:2006-09-12

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摘要： 目的 研究维持性血液透析（maintenance hemodialysis，MHD）患者血红蛋白水平变化并对其相关因素进行探讨，观察促红细胞生成素、右旋糖酐铁注射液、左旋卡尼汀注射液等联合治疗对改善MHD患者贫血的疗效。方法 选择上海市闸北区中心医院血液净化中心透析龄超过3个月的MHD患者60例，血红蛋白＜90g/L，有绝对缺铁或功能性缺铁，将患者随机分成3组，A组：(促红细胞生成素＋口服补铁)；B组：(促红细胞生成素＋静脉补铁)；C组：(促红细胞生成素＋静脉补铁＋静脉左旋卡尼汀注射液)。进行为期12周的治疗随访，分别检测血红细胞、血红蛋白、网织红细胞、血清铁蛋白、转铁蛋白饱和度、白蛋白、肉碱浓度以及透析充分性（Kt/V）和蛋白分解代谢率（PCR）。结果 ①3组治疗后血红蛋白都有升高，A组在治疗后血红蛋白升高相对较慢(P＜0.05)，B组第4周末较治疗前血红蛋白就有明显升高(P＜0.05)，C组在第4周末血红蛋白较治疗前就出现明显升高持续升高至第12周(P＜0.01)，并与同期A、B组比较差异有显著性（P＜0.01，P＜0.05）；②治疗至第4周时B、C组网织红细胞较治疗前明显升高（P＜0.05），但以后又逐渐降低，至第12周各组网织红细胞变化相对治疗前无明显差异(P＞0.05)。③A组铁蛋白、白蛋白、肉碱浓度较治疗前无明显变化(P＞0.05)；B组铁蛋白较治疗前显著升高(P＜0.01)白蛋白、肉碱浓度稍有升高，但差异无显著性(P＞0.05)；C组铁蛋白较治疗前显著升高(P＜0.01)，在治疗后第4周末白蛋白、肉碱浓度就升高较明显(P＜0.01)。④3组Kt/V治疗前后无明显变化(P＞0.05)，C组PCR值较治疗前明显上升(P＜0.05)。结论 各治疗组均能改善MHD患者的贫血状态，口服补铁(A组)与静脉补铁(B组)相比起效较慢，用左旋卡尼汀注射液联合静脉补铁(C组)改善贫血疗效明显。

关键词: 血液透析, 贫血, 血红蛋白

Abstract: Objective To investigate the effects of iron supplementation and levocarnitine on hemoglobin level in maintenance hemodialysis (MHD) patients. Methods Sixty MHD patients were randomly divided into three groups. All patients enrolled had undergone hemodialysis for at least three months before the study and were in an iron-deficiency status with anemia.In the group A,patients were treated with oral iron 600mg/d. In the group B, patients received an intravenous infusion of iron saccharate 100mg twice a week and the total dosage was 1000mg. In the group C, 1g of levocarnitine were infused to the patient at the end of each dialysis treatment. All the patients received three months’EPO therapy, while the parameters for hemoglobin，ferritin and nutritional state were studied. Results After three months’therapy, the average level of hemoglobin increased markedly in all groups (P＜0.05 respectively); And the average serum level of ferritin in group B and group C (P＜0.05 and P＜0.01 respectively) the average serum level of albumin and pre-albumin in group C were also elevated after the treatments; The average serum level of carnitine and protein catabolic rate (PCR) were significantly higher than the baseline in group C (P＜0.05 and P＜0.01), but not observed in the other two groups; Kt/V kept stable in the three groups(P＞0.05). Conclusion Intravenous supplementation of iron and levocarnitine in maintenance hemodialysis patients appears to be associated with an improvement in hemoglobin levels.

Key words: Anemia, Hemoglobin

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