The Correlation Of Erythropoietin Resistance And High Sensitivity C-reactive Protein

Background:Anemia is one of the most common clinical manifestations maintenance hemodialysis (maintenance hemodialysis,MHD) patients. The cause of the anemia is the EPO is not enough secreting by renal, malnutrition,gastrointestinal and hemodialysis bleeding, uremic toxins caused the destruction of the microenvironment of bone marrow, the life of red blood cells shortened compared by expectancy, combined blood system tumors directly affect the hematopoietic. Which erythropoietin (erythropoietin EPO),inadequate secretion is the main reason. With the of rhEPO (recombinant of human erythropoietin of rhEPO) widely used in clinical,making the most MHD patients with anemia will be corrected,further to its quality of life, ability to work and body resistance, survival has been significantly improved. According to the literature, After using the recommended dose of rhEPO approximately about90%to95%of patients in accordance, hemoglobin (of hemoglobin Hb)/hematocrit (hematocrit Hct of) levels were significantly increased, however,about5%to10%of patients need to use larger doses of rhEPO in order to achieve or can not reach the level of target which is referred to as EPO resi stance. Gunnell and other related study,regard the ratio of weekly EPO dose and Hct (EPO/Hct) as evaluation of erythropoietin prime indicators resistance, called hormone resistance index erythropoietin (erythropoietin resistance index, ERI).In the United States, the EPO-resistant patients is about4%; European EPO resistance in patients less than10%;Japanese hemodialysis patients with EPO resistance accounted for3.7%, the EPO resistance of peritoneal dialysis patients accounted for13.6%; The data of EPO resistance in dialysis patients in China The research data is still rare.Many reasons may lead to this phenomenon,the test will make the correlation of erythropoietin resistance and high sensitivity C-reactive protein to be studied. The high sensitivity C-reactive protein is a sensitive marker to distinguish between micro-inflammatory state, which clinical laboratory use advanced technology to detect low concentrations of C-reactive protein.Objective:This study by the detection of MHD patients with high sensitivity C-reactive protein (hypersensitive C-reactive protein, hs-CRP), ferritin, serum albumin, serum calcium, phosphorus and other indicators to explore the correlation of maintenance hemodialysis patients and promoteerythropoietin between the erythropoietin resistance and the micro-inflammatory markers C-reactive protein.Methods:In this study, a total of30cases of maintenance hemodialysis patients of blood purification center in Yunnan Dali Bai Autonomous Prefecture People’s Hospital during March2011to September2011, All patients underwent maintenance hemodialysis therapy more than four months and the regular use of rhEPO more than four months into the group of patients are divided into two groups according to the hemodialysis patients weekly rhEPO treatment dosage and Hct level:erythropoietin (EPO) resistance group (A) of rhEPO treatment dose>9000IU/W and Hct<25%, a total of11patients; non-erythropoietin (EPO) resistance group (B) of rhEPO therapy dose9000IU/W or<9000IU/W and33%<Hct<36%. A total of19patients,9of rhEPO treatment dose5000IU/W, Hct namely compliance. Observing the basic characteristics of the two group of patients, and hemoglobin, calcium, phosphorus, blood urea nitrogen, creatinine, albumin, high sensitivity C-reactive protein, ferritin. Sensitivity C-reactive protein and ferritin using nephelometry, other indicators such as hemoglobin, calcium, phosphorus, urea nitrogen, creatinine, albumin, by the Dali Bai Autonomous Prefecture People’s Hospital laboratory to assist. rhEPO in domestic was benefits of Biot, subcutaneous injection at the end of dialysis. Statistical analysis:All data with SPSS11.0statistical package, measurement data using compare two independent sample t test, count data using the X2test; the correlation between two factors using the Spearman rank correlation analysis; the EPO resistance index and other factors using multiple linear regression analysis.Results:1. The basic features of the two groups of patients The age, gender, the time of dialysis, frequency of dialysis, vascular access, there are no statistical difference. 2. Two groups of patients with serological parameters The Hb, Hct, of hs-CRP and ERI, the EPO, P have statistics significant difference. hs-CRP has a significant difference; Ab, Ca, Bun, Cr were not statistical difference.3. correlation analysis between parameters.Erythropoietin resistance index ERI respectively, super-sensitivity C-reactive protein of the logarithm of LN,(of hs-of CRP) was being related, the correlation coefficient r=0.444, P<0.05(there are statistically significant); serum phosphorus P was positively related to the relevant coefficient r=0.470, P<0.05(statistically significant); and serum albumin Alb negative, correlation coefficient r=-0.277, P=0.138(not significant).4. ERI as the dependent variable, multiple linear regression analysis ERI as the dependent variable, multiple linear regression analysis, xenophobia impact of EPO and Free, CRP, P is the the most important independent influence factors to the erythropoietin resistance.Conclusion:1. erythropoietin (EPO) resistance patient has a higher levels of high sensitivity C-reactive protein.2. EPO resistance index (ERI) and high sensitivity C-reactive protein, serum phosphate was significantly positively correlated, which indicates that the micro-inflammatory state, hyperphosphatemia is the impact of maintenance hemodialysis patients erythropoietin resistance factors.3. In case of erythropoietin hormone dosage is adequate and iron supplement is reasonable, high sensitivity C-reactive protein in maintenance hemodialysis patients is independent risk factor for hormone resistance is also an important indicator of EPO resistance.