Correction of iron-deficient erythropoiesis in the treatment of anemia of chronic disease with recombinant human erythropoietin
Correction of iron-deficient erythropoiesis in the treatment of anemia of chronic disease with recombinant human erythropoietin
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DOI：
10.1007/s00277-004-0950-z
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发表时间：
2005-03-01
影响因子：
3.5
通讯作者：
Möller, B
中科院分区：
文献类型：
--
作者：
Arndt, U;Kaltwasser, JP;Möller, B
慢性疾病贫血（ACD）是类风湿性关节炎（RA）慢性炎症的常见并发症。重组人促红细胞生成素（rHuEpo）已被证明可有效纠正ACD，尽管无反应率不同。该试验的第一个目的是改善铁缺乏性红细胞（IDE）患者通过肠外补铁对rHuEpo的反应。另一个目标是评估红细胞锌原卟氨酸含量（ZnPP），可溶性转铁蛋白受体（sTrfR）血清浓度，以及网状红细胞（CHr）血红蛋白（Hb）含量作为促红细胞生成的诊断和预后参数。30例RA合并ACD患者每周2次皮下注射150 IU rHuEpo/ kg体重。静脉补铁（每周一次200毫克蔗糖铁）被添加到IDE （n= 23）的病例中，其定义为存在三个标准中的两个：转铁蛋白（TrfS）饱和度小于或等于15%，低色红细胞（HypoE）大于或等于10%，血清铁蛋白（Fn）浓度小于或等于50马克杯/升。所有28名完成治疗的患者均达到了治疗目标，中位Hb浓度从10.3 g/dl增加到13.3 g/dl。在所有患者中，促生成素治疗和补铁是安全且耐受性良好的。每隔一周监测一次Fn、TrfS和HypoE，可成功矫正贫血。可评估参数(CHr, sTrfR，。和ZnPP)显示在这种情况下预测或监测IDE没有额外的好处，尽管其中一种或另一种可能在其他治疗情况下是有利的。
Anemia of chronic disease (ACD) is a frequent complication of chronic inflammation in rheumatoid arthritis ( RA). Recombinant human erythropoietin (rHuEpo) has been shown to be effective in correcting ACD, although with a variable rate of nonresponders. The first aim of this trial was to improve the response to rHuEpo by parenteral iron supplementation in cases of iron-deficient erythropoiesis (IDE). An additional goal was the evaluation of the zinc protoporphyrin content of erythrocytes ( ZnPP), the soluble transferrin receptor (sTrfR) serum concentration, and the hemoglobin (Hb) content of reticulocytes (CHr) in stimulated erythropoiesis as diagnostic and prognostic parameters. Thirty RA patients with ACD were treated with subcutaneous 150 IU rHuEpo/ kg body weight twice weekly. Intravenous iron supplementation ( 200 mg iron sucrose once weekly) was added in cases of IDE ( n= 23), which was defined by the presence of two of three criteria: saturation of transferrin ( TrfS) less than or equal to15%, hypochromic erythrocytes (HypoE) greater than or equal to10%, and a serum ferritin (Fn) concentration less than or equal to 50 mug/l. All 28 completers met the treatment goal, with an increase of the median Hb concentration from 10.3 g/dl to 13.3 g/dl. Epo treatment and iron supplementation was safe and well tolerated in all patients. Monitoring of Fn, TrfS, and HypoE every other week allowed a successful correction of anemia. Retrospective analysis of the evaluable parameters ( CHr, sTrfR,. and ZnPP) revealed no additional benefit for predicting or monitoring IDE in this setting, although the one or other may be advantageous in other therapeutic situations.