Recombinant erythropoietin compared with erythrocyte transfusion in the treatment of anemia of prematurity.
Recombinant erythropoietin compared with erythrocyte transfusion in the treatment of anemia of prematurity.
复制标题
重组促红细胞生成素与红细胞输注治疗早产儿贫血的比较。
DOI：
10.1016/s0022-3476(05)80303-8
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发表时间：
1991
期刊：
影响因子：
--
通讯作者：
Christensen,RD
中科院分区：
文献类型：
--
作者：
Ohls,RK;Christensen,RD
为了评估红细胞生成素与红细胞输注治疗早产儿贫血的风险和益处，我们随机分配了19例贫血早产儿（出生体重988±227 gm；胎龄27.6±1.2周；年龄41±15天；所有数值均为平均值±SD）接受输血或皮下注射促红细胞生成素（200单位/kg，每隔一天，共10次）。在10例红细胞生成素受体中，校正后的网织红细胞计数从2%±1%增加到7%±2% (p<0.001)，红细胞比容从27%±2%增加到30%±4% （p<0.05）。在接受输血的9名婴儿中，网织红细胞计数没有增加，但红细胞比容在初次输血后从28%±4%增加到41%±2% (p<0.001)，并在第20天降至34%±5%。红细胞生成素接受者和输血者的贫血症状（心动过速、呼吸暂停伴心动过缓、体重增加不佳）均有所下降。然而，接受输血的9名婴儿中有5名在10至14天内出现症状，并接受了进一步的输血。治疗7 ~ 10 d后骨髓穿刺显示，接受促红细胞生成素治疗的婴儿红细胞前体百分比更高（p<0.001），成熟红细胞祖细胞浓度更高（p<0.001），红细胞祖细胞循环率更高（p<0.001）。红细胞生成素组骨髓中储存的成熟中性粒细胞百分比低于输血组，导致骨髓/红细胞比例相反（0.5:1 vs 6.2:1;p<0.001）。20 d后，红细胞生成素组的绝对中性粒细胞计数（1.8±0.9×103cells/μl）低于输血组（3.9±1.9×103cells/μl, p<0.05）。因此，给药促红细胞生成素刺激了红细胞生成，减轻了贫血的症状；相对中性粒细胞减少的意义仍有待确定。我们的结论是，促红细胞生成素的管理提供了一种替代红细胞输注的早产儿症状性贫血新生儿的承诺。
To assess the risks and benefits of erythropoietin versus erythrocyte transfusion in the treatment of the anemia of prematurity, we randomly assigned 19 anemic preterm infants (birth weight 988±227 gm; gestational age 27.6±1.2 weeks; age 41±15 days; all values mean ±SD) to receive either transfusion or subcutaneously administered erythropoletin (200 units/kg every other day for 10 doses). In the 10 erythropoietin recipients, corrected reticulocyte counts increased from 2%±1% to 7%±2% (p<0.001) and hematocrits increased from 27%±2% to 30%±4% (p<0.05). In the nine infants who underwent transfusion, reticulocyte counts did not increase, but hematocrits increased from 28%±4% to 41%±2% after initial transfusion (p<0.001) and had decreased to 34%±5% by day 20. Signs attributed to anemia (tachycardia, apnea with bradycardia, and poor weight gain) declined in both the erythropoietin recipients and those who underwent transfusion. However, five of nine infants who underwent transfusion had symptoms within 10 to 14 days and were given further transfusions. Marrow aspiration performed after 7 to 10 days of treatment showed that intants receiving erythropoietin had greater percentages of erythropoietic precursors (p<0.001), greater concentrations of mature erythroid progenitors (p<0.001), and higher cycling rates of erythroid progenitors (p<0.001). The percentage of mature stored neutrophils in marrow was lower in the erythropoietin group than in the transfusion group, resulting in an inverse myeloid/erythroid ratio (0.5:1 vs 6.2:1;p<0.001). After 20 days, absolute blood neutrophil counts were lower in the erythropoietin recipients (1.8±0.9×103cells/μl) than in the infants who underwant transfusion (3.9±1.9×103cells/μl;p<0.05). Administration of erythropoietin thus stimulated erythropoiesis and relieved signs attributed to anemia; the significance of the relative neutropenia remains to be determined. We conclude that erythropoietin administration offers promise as an alternative to erythrocyte transfusion in neonates with symptomatic anemia of prematurity.