重组人红细胞生成素在肾性贫血中的应用进展

红细胞生成素是一种主要由肾脏合成和分泌的，刺激红系祖细胞产生红细胞的特殊激素，重组人红细胞生成素是现代分子技术的产物。近年来，对红细胞生成素的生理学，重组你红细胞生成素治疗肾性贫血的积极意义、可能并发症及征处理措施、临床应用原则等有越来越多的认识。本文综述近年来有关方面的研究进展。     

重组人体红细胞生成素在肾性贫血中的应用

重组人体红细胞生成素在肾性贫血中的应用大连医科大学附属第二医院（１１６０２３）闻立荣，尹永红重组人体红细胞生成素（ｒＨｕＥＰＯ、ＥＰＯＧＥＮ）不仅对纠正尿毒症贫血有特效，而且推进了尿毒症贫血生理病理学的发展。Ｅｓｃｈｂａｃｈ等［１］１９９２年报告对血...     

重组人促红细胞生成素治疗非肾性贫血

贫血的病因非常复杂，其中造血因子促红细胞生成素（EPO）缺乏是重要原因之一。1983年，人促红细胞生成素（hEPO）基因首次被分离克隆，并于1989年重组人促红细胞生成素（rhEPO）开始用于临床，对治疗肾性贫血已经取得了肯定疗效（有效率达90％以上），目前其适应证范围正在扩大，包括炎症、肿瘤、化疗及移植后贫血的治疗。近年来，大量的临床实验对小EP0治疗非肾性贫血的作用、给药方式剂量、不良反应等进行了评价。这些临床实验的主要结局为血红蛋白水平升高、输血量减少，临床情况包括总体生活质量（QOL）改善。     

基因重组人红细胞生成素的临床应用

基因重组人红细胞生成素的临床应用广东省人民医院血液内科黄铮人基因重组人红细胞生成素（ＥｐｏｇｅｎｒＨｕＥｐｏ）简称Ｅｐｏ，是一种能刺激红细胞增殖、分化及成熟的糖蛋白造血因子，也是第１个被用于临床的造血因子。Ｅｐｏ由近端肾小管邻近细胞所生成，刺激分泌的...     

国产重组人红细胞生成素对中老年肾性贫血疗效观察

目的观察国产和进口红细胞生成素（ｒｈＥＰＯ）治疗中老年慢性肾功能衰竭伴肾性贫血的疗效。方法将３８例慢性肾功能衰竭伴肾性贫血患者随机配对，用每周６０００单位国产和进口ｒｈＥＰＯ皮下注射，治疗１２周后观察全血红细胞、血清铁蛋白以及肾功能变化。结果２组在用药过程中血红蛋白（Ｈｂ）、红细胞压积（ＨＣＴ）、红细胞计数（ＲＢＣ）均逐渐上升，２组患者同周数配对χ２没有显著差别。２组患者治疗的显效率、有效率、总有效率经χ２检验，Ｐ＞０．０５，没有明显差别。在治疗过程中，２组患者血清铁蛋白均有下降。结论国产ｒｈＥＰＯ在治疗中老年肾性贫血与进口ｒｈＥＰＯ具有相同疗效，在ｒｈＥＰＯ治疗过程中需要补充铁剂     

重组人促红细胞生成素治疗慢性肾性贫血疗效观察

目的 探讨重组人促红细胞生成素（rhEPO）治疗慢性肾性贫血的临床疗效.方法 对42例慢性肾性贫血患者采用rhEPO治疗.治疗8周后判定临床疗效,并记录不良反应发生率;测定治疗前后Hb、网织红细胞（Rc）、红细胞压积（HCT）以及外周血异型红细胞百分率.结果 有效率为92.9%（39/42）,不良反应发生率为16.7%.治疗后HCT、Hb、Rc均明显升高（P＜0.01）, 异型红细胞明显减少（P＜0.01）.结论 rhEPO治疗慢性肾性贫血疗效确切,不良反应少.     

应用重组人红细胞生成素治疗老年人溶血性贫血

1989年以来陆续报道应用重组人红细胞生成素(recombinant human erythropoietin)治疗晚期肾脏疾病的贫血、骨髓浸润并发的恶性贫血、早产儿贫血、人类免疫缺陷病毒感染时齐多夫定诱发的贫血、骨髓发育不良综合征和类风湿性关节炎引起的贫血并取得成功。作者最近用重组人红细胞生成素成功地治疗两例患有风湿性心脏瓣膜病并做了人造瓣膜替换术的老年病人因红细胞破坏所致的溶血性贫血。例1女性,75岁。1985年因恩风湿性主动脉瓣狭窄和二尖瓣狭窄而做了双重人造瓣膜(Starr-Edwards主动脉瓣和Medtronic-Hall二尖瓣)替换术。18年前曾因车祸做了脾切除术,以后发生持久性白细胞增多和血小板增多。1992年7月因血红蛋白降     

重组人红细胞生成素治疗难治性贫血

重组人红细胞生成素治疗难治性贫血吴兴中，王学文，刘海宁，钱晓萍国外近年来应用基因重组人红细胞生成素（ｒＨｕＥＰＯ）治疗难治性贫血已显示一定的疗效，这些难治性贫血包括骨髓增生异常综合征（ＭＤＳ）－难治性贫血（ＭＤＳ－ＲＡ），再生障碍性贫血（再障），骨髓...     

合理应用人促红细胞生成素治疗肾性贫血

基因重组人促红细胞生成素(rHuEPO)是治疗肾性贫血的主要药物,2012年改善全球肾脏病预后组织(KDIGO)贫血治疗指南根据最新的研究结果对EPO在慢性肾脏病的应用规范提出了建议。本文将从血红蛋白目标值、EPO治疗的启动时机、给药方案、EPO的反应性等方面进行讨论,探寻更加合理的EPO应用策略。在纠正贫血的过程中,应兼顾EPO治疗的获益和风险。     

重组人促红细胞生成素治疗血液透析患者肾性贫血效果分析

目的采用促红细胞生成素抵抗指数(ERI)评价血液透析患者肾性贫血的治疗效果,并分析可能的影响因素。方法采用横断面研究方法,对2012年4月在四川大学华西医院血液透析中心行维持性血液透析的患者进行调查,按ERI指数分成3组:A组ERI<15,B组ERI 15～25,C组ERI>25。比较各组临床指标的差异,并通过相关性分析探讨ERI的影响因素。结果研究共纳入260例维持性血液透析患者,平均ERI为22.53±9.21。C组的超敏C反应蛋白(hs-CRP)、甲状旁腺激素(PTH)高于A、B组(P<0.05),而尿素清除指数(Kt/V)和转铁蛋白饱和度(TSAT)低于其他两组(P<0.05)。3组患者的白蛋白、血脂、铁蛋白差异无统计学意义。相关性分析显示,hs-CRP、PTH、Kt/V、TSAT是ERI升高的影响因素。结论促红细胞生成素治疗血液透析患者肾性贫血的效果受诸多因素影响,在调整药物剂量前应首先对相关因素进行评估和干预,以避免盲目增加药量而导致的副反应和治疗花费。     

重组人脑利钠肽治疗心肾综合征疗效研究

目的：观察重组人脑利钠肽（rhBNP）治疗心肾综合征患者的疗效。方法：回顾性分析在我院住院诊断为心肾综合征的患者75例的资料,按数字表法被随机分为：常规治疗组（40例,给予常规治疗）,rhBNP组（35例,在常规治疗的基础上加用 rhBNP）,rhBNP按0.0075μg·kg^-1·min^-1以微量泵静脉泵入,每天1次,每次持续约10 h,7d为1疗程,分别记录治疗前和7d后患者的24 h尿量、N末端脑利钠肽前体（NT-proBNP）、肾小球滤过率及心脏彩超的变化。结果：治疗后与常规治疗组比较, rhBNP 组总有效率（62.5％比94.3％）,24 h 尿量[（785.2±143.4）ml比（965.34±171.8）ml]、肾小球滤过率[（34.1±2.6）ml/min比（45.2±5.6）ml/min]、左室射血分数[（35.6±5.5）％比（45.9±6.8）％]显著升高,NT-proBNP [（3451.1±1314.2）pg/ml 比（1516.43±431.52）pg/ml]水平显著降低,差异有统计学意义（P均＜0.01）。结论：重组人脑利钠肽在心肾综合征患者治疗中安全有效,并能改善肾功能。     

Sugar profiling proves that human serum erythropoietin differs from recombinant human erythropoietin.

Erythropoietin (EPO) from sera obtained from anemic patients was successfully isolated using magnetic beads coated with a human EPO (hEPO)-specific antibody. Human serum EPO emerged as a broad band after sodium dodecyl sulfate-polyacrylamide gel electrophoresis, with an apparent molecular weight slightly smaller than that of recombinant hEPO (rhEPO). The bandwidth corresponded with microheterogeneity because of extensive glycosylation. Two-dimensional gel electrophoresis revealing several different glycoforms confirmed the heterogeneity of circulating hEPO. The immobilized anti-hEPO antibody was capable of binding a representative selection of rhEPO glycoforms. This was shown by comparing normal-phase high-performance liquid chromatography profiles of oligosaccharides released from rhEPO with oligosaccharides released from rhEPO after isolation with hEPO-specific magnetic beads. Charge analysis demonstrated that human serum EPO contained only mono-, di-, and tri-acidic oligosaccharides and lacked the tetra-acidic structures present in the glycans from rhEPO. Determination of charge state after treatment of human serum EPO with Arthrobacter ureafaciens sialidase showed that the acidity of the oligosaccharide structures was caused by sialic acids. The sugar profiles of human serum EPO, describing both neutral and charged sugar, appeared significantly different from the profiles of rhEPO. The detection of glycan structural discrepancies between human serum EPO and rhEPO by sugar profiling may be significant for diagnosing pathologic conditions, maintaining pharmaceutical quality control, and establishing a direct method to detect the misuse of rhEPO in sports.     

Effect of recombinant human erythropoietin in preterm infants.

Twenty-five premature infants (mean gestational age+/-SD, 31.4+/-1.9 weeks) were administered subcutaneously recombinant human erythropoietin (rHuEpo) at a dose of 300 u/kg of body weight three times a week beginning on the third day of life and continuing for 6 weeks. The controls (n=23) were premature infants with a mean gestational age of 32.2+/-2.3 weeks who did not receive rHuEpo. Haematological indices, haemoglobin and serum phosphate (Pi), and red blood cell (RBC) phosphate metabolites (ATP, 2,3-DPG, RBCPi) were tested monthly until the 6th month and thereafter at the 9th and 12th months of life. The level of serum soluble transferrin receptors (sTfR) correlated significantly with rHuEpo (p<0.05). The ratio of sTfR to log (ferritin) was significantly higher (p<0.001) in the infants treated with rHuEpo than the controls. Intracellular organic and inorganic Pi changes were not affected by the Epo administration. The RBC 2,3-DPG seemed adequate in infants receiving rHuEpo.     

Epidemiology of cardiorenal syndrome

The interdependence of cardiac and renal dysfunction has emerged as a focus of intense interest in heart failure management due to the substantial associated morbidity and mortality. Captured in the clinical entity known as cardiorenal syndrome, recent definitions afford discussion of the acute and longitudinal evaluation and management of these patients. This article discusses potential pathophysiologic mechanisms of cardiorenal syndrome, epidemiology, inpatient and long-term care (including investigational therapies and mechanical fluid removal), and end-of-life and palliative care.     

Improvement of mouse beta-thalassemia by recombinant human erythropoietin

Homozygous beta thalassemic mice received 50 U (1,660 U/kg) of recombinant human erythropoietin (rhEpo) 5 days a week for 2 weeks. Hemoglobin increased from 9.2 +/- 0.6 g/dL to 10.5 +/- 0.4 g/dL (P = .002) and hematocrit increased from 29.2% +/- 0.9% to 34.1% +/- 1.9% (P = .0014). The beta minor/alpha globin chain synthesis ratio increased slightly but significantly between day -4 (0.75 +/- 0.07) and day 4 (0.81 +/- 0.04) (P = .01) and reached a minimum ratio (0.67 +/- 0.03) on day 15 (P = .001), being parallel to reticulocyte counts and to the incorporated trichloracetic acid (TCA)-insoluble radioactivity, therefore parallel to the erythropoietic output in thalassemic mice, as in normal mice. Erythrocyte defects were improved in beta thalassemic mice treated by rhEpo: membrane-associated alpha globin was significantly decreased (P less than .01), thiol group reactivity of ankyrin was significantly improved (P less than .05), spectrin alterations were reduced, and deformability of mouse thalassemic red blood cells was normalized. These results provide experimental criteria for modulating globin chain imbalance necessary for the therapy of human beta thalassemia intermedia, and suggest that rhEpo might be of interest to improve the red blood cell mass and reduce erythrocyte alterations in this disease.