Anemia of inflammation.
Anemia of inflammation.
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DOI：
10.1016/j.hoc.2014.04.005
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发表时间：
2014-08
影响因子：
2.4
通讯作者：
Ganz, Tomas
中科院分区：
文献类型：
--
作者：
Nemeth, Elizabeta;Ganz, Tomas
炎症性贫血(AI，也称为慢性病贫血)是一种常见的、通常是由潜在的炎症性疾病引起的常红细胞等染色质贫血。当血清铁浓度低时，尽管有足够的铁储存，但血清铁蛋白并不低，这就是诊断。在炎症的背景下，AI可能很难与缺铁性贫血相鉴别，两种情况可能并存。在AI中，红细胞生成受到海普西丁介导的低铁血症的铁限制，红细胞生成受到作用于红系祖细胞的细胞因子的抑制。红细胞生成减少不能弥补因细胞因子激活的巨噬细胞的红细胞吞噬功能增强而导致的红细胞寿命缩短。治疗应侧重于基础疾病。如果这是不可行的，并且贫血限制了生活质量或日常活动的表现，红细胞生成刺激剂和静脉铁的组合可能是有效的，但只有在仔细考虑风险和好处后才能尝试。最近对AI分子理解的进展刺激了新的病理生理学靶向实验疗法的发展。
Anemia of inflammation (AI, also called anemia of chronic disease) is a common, typically normocytic normochromic anemia that is caused by an underlying inflammatory disease. It is diagnosed when serum iron concentrations are low despite adequate iron stores, as evidenced by serum ferritin that is not low. In the setting of inflammation, AI may be difficult to differentiate from iron deficiency anemia, and the two conditions may coexist. In AI, erythropoiesis is iron-restricted by hepcidin-mediated hypoferremia and erythrocyte production is suppressed by cytokines acting on erythroid progenitors. Decreased erythropoiesis is unable to compensate for shortened erythrocyte lifespan caused by enhanced erythrophagocytosis by cytokine-activated macrophages. Treatment should focus on the underlying disease. If this is not feasible and the anemia limits the quality of life or the performance of daily activities, a combination of erythropoiesis-stimulating agents and intravenous iron may be effective but should be attempted only after careful consideration of risk and benefit. Recent advances in molecular understanding of AI are stimulating the development of new pathophysiologically targeted experimental therapies.
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