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目的：分析促红细胞生成素(erythropoietin,EPO)联合限制性输血方案对维持性血液透析(maintenance hemodialysis,MHD)患者贫血纠正效果及血清铁调素、炎症因子的影响。方法：96例MHD贫血患者，随机分为常规组和观察组各48例。常规组采用EPO联合常规自由输血方案治疗，观察组采用EPO联合限制性输血方案治疗。比较两组治疗12周后贫血纠正效果，铁代谢指标、微炎症状态及氧化应激指标、输血相关指标、生活质量和体能状态以及不良反应。结果：治疗后观察组血红蛋白(hemoglobin,Hb)[(115.83±9.71)g/L vs(105.15±8.82)g/L]、红细胞压积(hematocrit,Hct)[(35.95±3.31)%vs(32.08±3.05)%]、网织红细胞计数(reticulocyte,Ret)[(68.52±6.93)×109/L vs(59.61±6.25)×109/L]，网织红细胞血红蛋白含量(reticulocyte hemoglobin content,CHr)[(33.45±2.87)pg vs(30.12±2.64)pg]水平高于常规组(均P<0.05)。治疗后观察组铁调素水平[(28.39±4.21)μg/L vs(35.68±5.32)μg/L]、可溶性转铁蛋白受体(soluble transferrin receptor,sTfR)[(2.12±0.45)mg/L vs(2.89±0.61)mg/L]低于常规组，转铁蛋白饱和度(transferrin saturation,TSAT)[(30.45±4.12)%vs(25.36±3.87)%]水平高于常规组(均P<0.05)。治疗后观察组肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)[(14.18±2.71)pg/mL vs(18.89±3.12)pg/mL]、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)[(3.08±0.81)mg/L vs(5.41±1.07)mg/L]、红细胞内活性氧(reactive oxygen species,ROS)[(655.82±89.47)MFI vs(815.69±105.24)MFI]、晚期氧化蛋白产物(advanced oxidation protein products,AOPP)[(85.47±18.32)μmol/L vs(105.63±21.09)μmol/L]水平低于常规组(均P<0.05)。观察组3个月内输血率6.25%，人均红细胞输注量(0.21±0.07)U，低于常规组的16.67%和(0.49±0.11)U(均P<0.05)。治疗后观察组慢性肾脏病生活质量量表(kidney disease quality of life short form,KDQOL-SFTM)评分[(75.68±7.14)分vs(68.45±6.87)分]、6分钟步行试验(6-minute walk test,6MWT)距离[(365.78±40.25)m vs(328.54±38.76)m]、握力[(26.89±3.87)kg vs(24.12±3.52)kg]高于常规组(均P<0.05)。观察组不良反应发生率2.08%，常规组为4.17%，差异无统计学意义(P>0.05)。结论：促红细胞生成素联合限制性输血方案能更有效纠正维持性血液透析患者的贫血状态，提升患者的生活质量与体能状态，显著改善铁代谢紊乱，其作用机制可能与下调血清铁调素水平、减轻微炎症状态和氧化应激反应有关。
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基本信息:
DOI：10.19767/j.cnki.32-1412.2026.03.010
中图分类号:R556;R692.5
引用信息:
[1]涂彩琼,赖婷婷,吴冰萍,等.促红细胞生成素联合限制性输血方案对维持性血液透析患者贫血纠正效果及血清铁调素、炎症因子的影响[J].交通医学,2026,40(03):275-279.DOI:10.19767/j.cnki.32-1412.2026.03.010.
2025-12-08
2025
2026-03-24
2026
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2026-06-20
2026-06-20