維持血液透析患者不同血管通路類型與紅細(xì)胞生成素劑量的相關(guān)性分析1

[摘要] 目的探討維持血液透析患者在血紅蛋白達(dá)標(biāo)的情況下不同血管通路類型與紅細(xì) 胞生成素( EPO)劑量之間的關(guān)系。方法回顧性分析2014年1月-2014年6月北京三家醫(yī)院血液凈化中心115例維持血液透析患者的臨床資料，比較自體動(dòng)靜脈內(nèi)瘺(AVF)與中心靜脈導(dǎo)管 ( cvc)血液透析患者的EPO劑量，采用單因素及多重線性回歸分析分析影響EPO劑量的獨(dú)立因素。結(jié)果115例患者中自體內(nèi)瘺85例，中心靜脈導(dǎo)管30例，兩組患者血清白蛋白、鐵蛋白、甲狀 旁腺激素水平及KU，比較差異無統(tǒng)計(jì)學(xué)意義。中心靜脈導(dǎo)管患者標(biāo)化EPO劑量明顯高于內(nèi)瘺患 者[每周( 151. 03±55.11)IU/kg與(118.42±49.78)IU/kg，P=0. 003]。中心靜脈導(dǎo)管患者每周平均EPO劑量較內(nèi)瘺患者增加27.5%。結(jié)論血管通路類型是影響血液透析患者EPO劑量的獨(dú)立因素，中心靜脈導(dǎo)管患者較自體內(nèi)瘺患者需要更多的EPO才能達(dá)到相同的血紅蛋白目標(biāo)值水平。 [關(guān)鍵詞]血液透析；血管通路； 自體動(dòng)靜脈內(nèi)瘺； 中心靜脈導(dǎo)管；紅細(xì)胞生成素

   The association between the different type of vascular access and erythropoitin dose in patients with maintenance hemodialysis Lu Fangping* , Li Han, Mao Yon,ghui, et al. *Department of Nephrology,First Hospital of Tsinghua University,Beijing 100016,China [Abstract] ob[x]jective To investigate the association between the type of vascular access anderythropoietin(EPO) dose in maintenance hemodialysis( MHD) patients with targeted hemoglobin level.Methods We selected 115 patients on MHD met inclusion and exclusion criteria retrospectively during the period from January 2014 to June 2014 from three hospitals in Beijing and compared the difference ofEPO dose between arteriovenous fistula( AVF) and central venous ( CVC) group. Univariable analysis followed by multiple liner regression analysis was performed to identify the independent risk factors for EPO dose. Results There were similar serum femtin, albumin,iPTH level between AVF and CVC patients. However, EPO dose were significant higher in CVC patients compared with AVF patients( P < 0. 05) . It had been associated with increase in total weekly EPO dose by 27. 5% in CVC patients.Conclusion The type of vascular access is an independent factor influencing EPO dose in MHD patients with targeted serum hemoglobin level.
[Keywords] Hemodialysis; Vascularaccess; Arteriovenousfistula; Centralvenouscatheter;Erythropoietin
    貧血是慢性腎臟病患者常見的并發(fā)癥，維持血液 透析患者貧血發(fā)生率高達(dá)99%左右[1]。目前普遍應(yīng)用紅細(xì)胞生成素( EPO)治療慢性腎臟病貧血，但只有部分患者能達(dá)到理想的血紅蛋白目標(biāo)值[2]。臨床實(shí)踐中發(fā)現(xiàn)達(dá)到血紅蛋白目標(biāo)值所需EPO的劑量差異 較大，有許多因素影響EPO的療效。近年來發(fā)現(xiàn)血管通路也是影響EPO劑量的因素之一[3]。但對(duì)于血紅蛋白達(dá)標(biāo)的血液透析患者血管通路類型對(duì)EPO劑量的影響的研究尚少，我們對(duì)北京三家醫(yī)院血液透析中心進(jìn)行回頤性橫斷面調(diào)查，探討血紅蛋白達(dá)標(biāo)的維持血液透析患者血管通路類型對(duì)EPO劑量的影響。