徐冷楠, 陈献广, 李传保, 孙颖, 刘昕, 毛永辉. 网织红细胞血红蛋白含量对维持性血液透析患者贫血治疗的指导意义[J]. 临床肾脏病杂志, 2020, 20(11): 853-856. DOI: 10.3969/j.issn.1671-2390.2020.11.001
    引用本文: 徐冷楠, 陈献广, 李传保, 孙颖, 刘昕, 毛永辉. 网织红细胞血红蛋白含量对维持性血液透析患者贫血治疗的指导意义[J]. 临床肾脏病杂志, 2020, 20(11): 853-856. DOI: 10.3969/j.issn.1671-2390.2020.11.001
    XU Leng-nan, CHEN Xian-guang, LI Chuan-bao, LIU Xin, SUN Ying, MAO Yong-hui. Significance of reticulocyte hemoglobin content in the treatment of anemia in maintenance hemodialysis patients[J]. Journal of Clinical Nephrology, 2020, 20(11): 853-856. DOI: 10.3969/j.issn.1671-2390.2020.11.001
    Citation: XU Leng-nan, CHEN Xian-guang, LI Chuan-bao, LIU Xin, SUN Ying, MAO Yong-hui. Significance of reticulocyte hemoglobin content in the treatment of anemia in maintenance hemodialysis patients[J]. Journal of Clinical Nephrology, 2020, 20(11): 853-856. DOI: 10.3969/j.issn.1671-2390.2020.11.001

    网织红细胞血红蛋白含量对维持性血液透析患者贫血治疗的指导意义

    Significance of reticulocyte hemoglobin content in the treatment of anemia in maintenance hemodialysis patients

    • 摘要: 目的 探讨维持性血液透析(maintenance hemodialysis,MHD)贫血的管理及网织红细胞血红蛋白含量(reticulocyte hemoglobin content,CHr)在治疗中的指导作用。方法 收集2019年10月1日至2020年1月31日于北京医院血液净化中心行MHD患者的人口学资料,血红蛋白(hemoglobin,Hb)、血清铁蛋白(serum ferritin,SF)、转铁蛋白饱和度(transferrin saturation,TSAT)、CHr等;红细胞生成素(erythropoietin,EPO)和铁剂应用情况。结果 共入选148例。Hb达标(110~120 g/L)占35.14%。SF、TSAT和CHr均在目标范围内。SF与C反应蛋白(C-reactive protein,CRP)显著相关(r=0.175,P=0.037),而CHr无此表现(P=0.054)。在除外了CRP升高的患者后,SF与CHr由不相关变为明显相关(r=0.272,P=0.004)。单纯根据Hb调整EPO用量,Hb达标率不理想。CHr持续降低者,铁剂未调整,即使EPO加量,HB也无法达标;CHr涨至正常范围者,铁剂增加,在未增加EPO的情况下,Hb亦达标。结论 CHr是更稳定的可以反映近期铁储备的指标,结合CHr进行铁剂的补充,能更好的改善贫血情况。

       

      Abstract: Objective To investigate the management of maintenance hemodialysis(MHD)anemia and the role of reticulocyte hemoglobin content(CHr)in its treatment.Methods Data of the patients,who underwent MHD from October 1,2019 to January 31,2020 at Beijing Hospital's Blood Purification Center,were collected:demographic data,hemoglobin(Hb),serum ferritin(SF),transferrin saturation(TSAT),CHr,etc.;application of erythropoietin(EPO)and iron preparations.Results A total of 148 people were enrolled.Patients with Hb compliance with the reference range accounted for 35.14%.SF,TSAT and CHr were all within the target range.SF was significantly correlated with C-reactive protein(CRP)(r=0.175,P=0.037),while CHr was not(P=0.054).After excluding patients with elevated CRP,SF and CHr changed from non-correlation to significant correlation between them(r=0.272,P=0.004).By simply adjusting the dosage of EPO based on Hb,the rate of Hb compliance was not ideal.Patients with CHr decreased continually and the iron preparation was not adjusted;even if the dosage of EPO was increased,Hb could not meet the standard.CHr increased to the normal range,while the iron preparation dose was increased,and the Hb also reached the standard without increasing the EPO.Conclusions CHr is a more stable indicator that can reflect the recent iron reserve.Supplementing Iron preparation combined with CHr can better improve the situation of anemia.

       

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