Anemia in elderly patients: an emerging problem for the 21st century.
Anemia in elderly patients: an emerging problem for the 21st century.
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DOI：
10.1182/asheducation-2010.1.271
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发表时间：
2010-12
期刊：
影响因子：
--
通讯作者：
G. Vanasse;N. Berliner
中科院分区：
文献类型：
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作者：
G. Vanasse;N. Berliner
贫血是老年患者的一个重要问题。虽然许多贫血的老年患者可以被诊断为营养缺乏症，慢性炎症性贫血或共病疾病，解释他们的红细胞压积下降，贫血的病因在很大一部分仍然不清楚。有证据表明，随着年龄的增长，造血干细胞对红细胞生成素（EPO）的抵抗力增强。EPO水平在老年非贫血患者中升高，据推测，这种对EPO的需求增加与衰老肾脏产生足够激素以满足该需求的能力下降之间存在相互作用。有进一步的大量证据表明，衰老与促炎细胞因子表达增加有关，并且这些细胞因子中的许多可导致EPO不敏感性。因此，这些促炎细胞因子表达的遗传变异可能通过诱导铁调素表达（炎症性贫血）和通过红系细胞集落形成的细胞因子抑制来影响老年患者贫血的发展。炎症介质、EPO不敏感性和其他可能作用于造血干细胞以减少红细胞生成的因素的影响正在积极研究中，并应有助于阐明老年人发病率和死亡率这一重要原因的病理生理学。更好地了解老年患者贫血的病理生理学应该为干预措施提供关键的切入点，这些干预措施将提高老年人群的生存率和生活质量。
Anemia is a significant problem in elderly patients. Although many anemic elderly patients can be diagnosed with nutritional deficiency, anemia of chronic inflammation or comorbid diseases that explain their decreased hematocrit, the etiology of anemia in a significant fraction remains obscure. There is evidence to suggest that the hematopoietic stem cell displays increasing erythropoietin (EPO) resistance with age. EPO levels rise in elderly, nonanemic patients, and it is hypothesized that there is an interplay between this rising demand for EPO and the decreasing ability of the aging kidney to produce adequate hormone to meet that need. There is further considerable evidence that aging is associated with increased proinflammatory cytokine expression and that many of these cytokines can contribute to EPO insensitivity. Consequently, genetic variation in the expression of these proinflammatory cytokines may influence the development of anemia in elderly patients, both through induction of hepcidin expression (anemia of inflammation) and through cytokine suppression of erythroid colony formation. The impact of inflammatory mediators, EPO insensitivity, and other factors that may act on the hematopoietic stem cell to decrease erythropoiesis are under active study and should serve to elucidate the pathophysiology of this important cause of morbidity and mortality in elderly individuals. A better understanding of the pathophysiology of anemia in elderly patients should provide critical entry points for interventions that will improve survival and quality of life in the aging population.