维持性血液透析患者促红细胞生成素低反应性的相关因素分析

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1、FACTORSINFLUENCINGERYTHROPOIETINHYPO—RESPONSIVENESSINMAINTENANCEHEMODIALYSISPATIENTSMasterStudent：ZhangLeiSpeciality：GeraeologyTutor：CuiMeiyuAssociateprofessorAbstractBackground：Firstofall，erythropoietin(EPO)wasfoundbyCarnoteta1in1906，alongwiththedevelopmentofgenetechn

2、ology，recombinanthumanerythropoietin(rHuEPO)beginitsclinicalapplicationin1986，anditsintroduc．tionisconsideredoneofthegreatestprogressinend．stagerenaldiscase(ESRD)patientsondialysisforthetreatmentofanemia．Itnotonlycantortecttheanemlainpatientswithend-stageuremia，butalso

3、improvetheirqualityoflife．workintensityandimprovetheirabilitytowork，strengthentheirbodvresistance,theoccurrenceofinfectiondecreasedandsignificantlyprolongedsurvivaltime·TheresponsetoEPOvariesamongindividualpatients．Accordingtotheliterature，approximately90％一95％ofrenalan

4、emiarespondedinadose。dependentmannertoEPO，whereastheremaining5％．10％ofpatientshadabluntedornoresponsetoEPO，despitehigh-dosetherapy．ThisisknownasEPOhypo。responsivenessorEPOresistance．Variousfactorsthathavebeenreportedtoberelatedtothishypo—responsiveness，oneofirondeficien

5、cvisthemajorfactor，followedbyinfection／inflammation，malnutrition，secondarvhyperparathyroidism，aluminumpoisoningangiotensin—convertingenzymeinhibitorcancauseEPOresistance，Inaddition。(ACEI)andangiotensinIIreceptorantagonistcanalsoaffectthecurativeeffectofrHuEPO．AttheUnit

6、edStates．EPOresistanceinpatientshasaround4％；EuropeanEPOresistanceinpatientshasnomorethan1O％；JapanEPOresistanceinhemodialysispatientsaccountedfor3·7％，peritonealdialysispatientswithEPOresistanceaccountedfor13．6％：inChina，thereisnoprecisereports．Objective：Inthispaper，thepr

7、esentstudywasaimedatinvestigatingthefactorssuchasCreactiveprotein，serumalbumin，normalizedproteincatabolicrate(nPCR)andimmunoreactiveparathyroidhormone，toinvestigatefactorsthatcanpredictEPOhypo-responsivenessorEPOresistanceinagroupofpatientsonmaintenancehemodialysisdial

8、ysis(MHD)．MaterialandMethods：Acohortof37patientstakingregularhemodia‘lysisbetweenJan．2008andDec．2008inourcenterwasstu