应用人基因重组红细胞生成素治疗尿毒症腹透患者贫血

应用人基因重组红细胞生成素（ｒＨｕＥｐｏ）治疗１０６例尿毒症腹透患者贫血。治疗前Ｈｃｔ≤２５％。起始剂量１００Ｕ／Ｋｇ，每周３次。病例随机分为皮下和静脉治疗组。结果治疗后所有患者贫血均有明显纠正，２０周内９６．２％患者Ｈｃｔ≥３０％。维持剂量为１８７Ｕ．ｋｇ（－１）周。皮下组治疗早期Ｈｃｔ上升幅度显著高于静脉组，维持剂量亦显著低。缺铁、血浆ＰＴＨ明显升高和感染等降低ｒＨｕＥｐｏ疗效。治疗２０周血压升高和缺铁发病率分别为２８．３％和２３．３％。老年患者疗效稍差，易出现血压升高和缺铁。研究表明，ｒＨｕＥｐｏ能有效纠正尿毒症腹透患者贫血，皮下注射疗效较好，应密切随访血压和铁代谢等。     

促红细胞生成素与肾性贫血研究进展

肾性贫血的最主要原因是促红细胞生成素(EPO)缺乏。人类重组促红细胞生成素(rHuEPO)应用于临床后，明显改善了终末期肾脏病病人的临床症状和生活质量。本文就EPO的生理、病理特征和rHuEPO的临床应用现状及研究进展作一综述。     

肾性贫血与促红细胞生成素

本文详细阐述了促红细胞生成紊（EPO）的产生、分子结构、作用机制以及欧美、日本的最新治疗指南，促红细胞生成紊治疗肾性贫血的靶目标值，促红细胞生成紊使用时铁剂补充的靶目标值以及促红细胞生成素治疗肾性贫血的优点、副作用。     

重组促红细胞生成素基因转导细胞治疗肾性贫血的调控研究

将促红细胞生成素(EPO)的cDNA通过各种手段导人动物细胞，使EPO基因在体内得到长期、稳定的表达，持续生成内源性EPO，从根本上解决EPO的来源，是治疗肾性贫血及其他贫血最佳的方法。EPO在体内含量甚微，必须保持一定的生理范围才能满足机体需要，如果产生过量，则对身体有害。因此，研究EPO表达水平的开、关调控，在EPO持续高效表达的同时，实现EPO表达的有效开关控制，是EPO治疗贫血的重要问题。     

促红细胞生成素与肾性贫血研究进展

肾性贫血的最主要原因是促红细胞生成素 (EPO)缺乏。人类重组促红细胞生成素 (rHuE PO)应用于临床后 ,明显改善了终末期肾脏病病人的临床症状和生活质量。本文就EPO的生理、病理特征和rHuEPO的临床应用现状及研究进展作一综述     

重组人红细胞生成素治疗肾性贫血的疗效分析

目的:探讨不同透析方式影响重组人红细胞生成素的疗效。方法:75例病人分为血液透析、腹膜透析、无透析三组。分别在用药前后测定三组病人的贫血程度(血红蛋白、红细胞、红细胞压积)。结果:同组病人用药前与用药8周后的贫血程度有显著差异性(P<0.01),但三组之间对比无差异性(P>0.05)。结论:提示重组人红细胞生成素治疗肾性贫血有明显效果,但不同透析方式不影响其疗效。     

重组促红细胞生成素基因转导细胞治疗肾性贫血的调控研究

将促红细胞生成素 (EPO)的cDNA通过各种手段导入动物细胞 ,使EPO基因在体内得到长期、稳定的表达 ,持续生成内源性EPO ,从根本上解决EPO的来源 ,是治疗肾性贫血及其他贫血最佳的方法。EPO在体内含量甚微 ,必须保持一定的生理范围才能满足机体需要 ,如果产生过量 ,则对身体有害。因此 ,研究EPO表达水平的开、关调控 ,在EPO持续高效表达的同时 ,实现EPO表达的有效开关控制 ,是EPO治疗贫血的重要问题。     

罗沙司他胶囊对比重组人促红素注射液治疗维持性血液透析肾性贫血的有效性及安全性

目的 比较罗沙司他胶囊和重组人促红素注射液（rhEPO）治疗维持性血液透析患者肾性贫血的有效性和安全性。方法 选取2020年9月至2020年11月在本院进行维持性血液透析治疗的40例肾性贫血患者,采用随机抽签法将其分为试验组和对照组,每组各20例。试验组使用罗沙司他胶囊治疗,对照组使用rhEPO治疗,研究进行12周。比较两组患者的红细胞计数（RBC）、血红蛋白（Hb）、红细胞比容（Hct）、铁蛋白（SF）、转铁蛋白（TRF）、转铁蛋白饱和度（TS）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）及不良反应。结果 治疗前,两组的RBC、Hb、Hct、SF、TRF、TS、TG、TC、LDL比较,差异均无统计学意义 (均P>0.05),治疗12周后,试验组的RBC、Hb、Hct、SF、TRF、TS均高于对照组,而试验组的TG、TC、LDL均低于对照组,差异均有统计学意义（均P<0.05）。两组均无严重不良反应出现。结论 罗沙司他胶囊可以明显改善维持性血液透析患者的肾性贫血,还可降低血脂水平,改善患者铁的利用率,其药效起效快,耐受性好,安全性较高,对肾性贫血患者是一种很好的选择。     

维持性血液透析患者重组人红细胞生成素治疗剂量的影响因素

目的分析影响维持性血液透析（MHD）患者重组人红细胞生成素（rHuEPO）治疗剂量的因素。方法选择72例血红蛋白（Hb）达标（≥100g／L）的MHD患者,分析每周rHuEPO治疗剂量与糖尿病、使用血管紧张素转化酶抑制剂（ACEI）和（或）血管紧张素受体拈抗剂（ARB）、微炎症、缺铁、联合血液透析滤过（HDF）治疗、透析充分、继发性甲状旁腺功能亢进（SHPT）、低蛋白血症等临床因素的相关性。结果有糖尿病组较无糖尿病组、使用ACEI和（或）ARB组较未用ACEI和（或）ARB组、有微炎症组较无微炎症组、缺铁组较不缺铁组每周rHuEPO治疗剂量均增加（P〈0．05）。而是否联合HDF治疗、透析是否充分、有无SHPT、有无低蛋白血症,每周rHuEPO治疗剂量均无差异（P〉0．05）。结论糖尿病、使用ACEI和（或）ARB、微炎症、缺铁影响MHD患者rHuEPO治疗剂量。     

The effects of recombinant human erythropoietin on growth and nutritional status

The availability of recombinant human erythropoietin (rhuEPO) has dramatically improved the care of children with chronic renal failure (CRF). Its use provides the opportunity to determine the relative contribution of anemia to the morbidity of CRF. Growth retardation, one of the most significant complications of CRF in children, is the consequence of several inter-related processes, including decreased protein and energy intake, metabolic bone disease, endocrine abnormalities, and anemia. The literature on the use of rhuEPO in children and data from a United States phase III double-blind, placebo-controlled study of rhuEPO in pediatric dialysis patients are reviewed to determine the effect of rhuEPO treatment on the nutritional status and growth of children with CRF. Despite subjective increases in appetite, there were no consistent improvements in dietary intake or anthropometric measures observed during rhuEPO treatment. Children gained weight during rhuEPO treatment; however, this was not generally associated with increased weight standard deviation scores. There was an improvement in growth velocity in some children; however, improvements in height standard deviation scores were infrequently seen. On review of the available literature, correction of anemia with rhuEPO has not been shown to improve the growth of children with CRF.     

腹膜透析与血液透析患者肾性贫血治疗效果比较

目的比较腹膜透析（peritoneal dialysis,PD）与血液透析（hemodialysis,HD）患者肾性贫血的治疗效果。方法选择尿毒症行肾脏替代治疗患者90例,其中腹膜透析患者41例,血液透析患者49例。患者入组前1个月内均未行肾脏替代治疗、未使用促红细胞生成素（erythropoietin,EPO）、无失血;在肾脏替代治疗开始时加用EPO,比较腹膜透析组（PD组）和血液透析组（HD组）患者治疗前、治疗后第1、2、3个月血红蛋白（hemoglobin,Hb）的变化,以及PD组与HD组治疗后3个月超敏C反应蛋白（high sensitivity C reactive protein,hs—CRP）、血白蛋白（albumin,Alb）、尿素清除指数（Kt／V）的差异。结果治疗前2组的Hb值无统计学差异（P〉O．05或P〉0．01）,治疗后第3个月2组的hs-CRP、Alb、Kt／V值无统计学差异（P〉0．05或P〉0．01）。透析治疗前后比较,PD组治疗后第1、2、3个月的Hb值均较治疗前升高（P〈0．05或P〈0．01）,且治疗后第3个月〉第2个月〉第1个月;HD组治疗后第1、2、3个月的Hb值均较治疗前升高（P〈0．05或P〈0．01）,且治疗后第3个月〉第2个月〉第1个月。PD组治疗后第1、2、3个月EPO的Hb值分别高于HD组,差异具有显著性（P〈0．01）。结论肾脏替代治疗、使用EPO可有效纠正尿毒症患者的肾I生贫血,PD患者使用EP0更有利于肾陛贫血的纠正。     

Recombinant human erythropoietin therapy in pediatric patients receiving long-term peritoneal dialysis

We evaluated the impact of (s.c.) recombinant human erythropoietin (r-HuEPO) therapy on the hematological status, exercise capacity, and dietary intake of nine pediatric patients (mean age 12.4±3.2 years) receiving long-term peritoneal dialysis. Five children without medical illness served as controls for the exercise testing portion of the study. Following 7.9±2.8 weeks of twice weekly r-HuEPO (50 units/kg per dose), the hematocrit increased from 21.9±3.5% to 31.3±2.5% (P<0.001). A further increase to 33.2±3.0% occurred after 2 months of once weekly therapy. The blood transfusion requirement decreased from 0.5 transfusions per patient-month to 0.05 transfusions per patient-month (P<0.01). Graded exercise testing demonstrated an increase in peak oxygen consumption from 17.8±5.2 to 24.0±7.6 ml/kg per min (P<0.01). The oxygen consumption at anaerobic threshold increased from 13.1±3.9 to 17.1±3.5 ml/kg per min (P<0.02). Treadmill time increased from 5.3±1.2 to 7.5±1.3 min (P<0.001). In each case, the percentage improvement was significantly greater than the improvement seen in the control population. Dietary evaluation revealed no significant change in caloric or protein intake, despite a subjectively improved appetite. r-HuEPO, given by the s.c. route, corrects the anemia and improves the exercise capacity of pediatric patients receiving long-term peritoneal dialysis.     

左卡尼汀对血液透析患者肾性贫血和左心功能的影响

目的观察左卡尼汀联合人重组促红细胞生成素（〉HuEPO）对维持性血液透析（MHD）患者肾性贫血、左心功能的影响。方法将78例MHD患者随机分为对照组和治疗组,每组39例。治疗组于每次血液透析结束时静脉注射左卡尼汀1.0g;对照组每次血液透析结束时静脉注射生理盐水5ml。疗程均为6个月。2组同时于血液透析后皮下注射r-HuEPO（每周75-150U／kg）。观察2组治疗前后的临床症状、体征相关的实验室检查以及超声心动图的变化。结果治疗组治疗后3个月患者血红蛋白（Hb）、红细胞压积（Hct）、血清白蛋白（Alb）、前白蛋白（PA）水平显著高于治疗前及同期对照组（P〈0.01）,〉HuEPO用量减少,且患者精神状态、体力、食欲、恶心、呕吐、透析耐受性、透析中肌痉挛、心律失常或低血压等症状明显改善,治疗后6个月患者左心功能较治疗前及同期对照组明显改善（P〈0.01）。结论左卡尼汀联合r-HuEPO可以明显改善尿毒症血液透析患者肾陛贫血和左心功能。     

应用红细胞生成素改善血液透析患者的营养状况

目的　了解红细胞生成素（EPO）对血液透析患者营养状况的影响。方法对25例血透患者在应用红细胞生成素前，治疗后3月、6月分别进行营养状况的评价，包括膳食摄入分析、人体学、生化指标和血浆氨基酸谱的测定。结果红细胞生成素治疗后的蛋白质、能量摄入以及各营养指标均较治疗前增加，其中以治疗6月后的蛋白质、能量摄入和三头肌皮褶厚度（TSF）、转铁蛋白（TF）、纤维连接蛋白（FN）的增加更为显著。血浆氨基酸中，亮氨酸、缬氨酸和丝氨酸在治疗后有增加，精氨酸、鸟氨酸和甘氨酸则有下降，尤以6月后的变化更为显著。结论红细胞生成素在纠正血透患者贫血的同时可改善其营养状况。     

血液透析与腹膜透析改善肾性贫血的疗效比较

目的 分析血液透析与腹膜透析对肾性贫血的疗效.方法 回顾性分析2013年1月至2015年6月52例尿毒症维持性透析患者的临床资料,其中维持性血液透析患者28例,维持性腹膜透析患者24例,两组患者均使用促红细胞生成素,联合叶酸、蔗糖铁治疗.比较两组患者治疗3个月后血红蛋白浓度变化.结果 治疗前,维持性血液透析组患者血红蛋白浓度与维持性腹膜透析组相比差异无统计学意义.治疗3个月后,两组患者血红蛋白浓度均较治疗前明显升高,但腹膜透析组患者血红蛋白浓度升高更为明显,与血液透析组患者相比差异有统计学意义.结论 血液透析和腹膜透析均能改善透析患者肾性贫血,但腹膜透析效果更明显.     

The influence of steroid therapy and recombinant human erythropoietin on the growth of children with renal disease

Long-term steroid therapy has a depressant effect on hypothalamo-pituitary pulsatile secretion of growth hormone (GH), and this results in an attenuated pubertal growth spurt. Oxandrolone and recombinant human GH improve growth rates in children taking long-term steroid therapy for renal disease, but there are potential side effects. Treatment with recombinant human erythropoietin improved the growth of three prepubertal, but not three pubertal haemodialysis patients.     

Effect of carnitine supplementation on lipid profile and anemia in children on chronic dialysis

We prospectively evaluated the effects of L-carnitine supplementation on plasma free carnitine (FC) levels, serum lipid profile, and erythropoietin (rhEPO) requirement in 24 children treated with peritoneal dialysis (PD; n = 16) or hemodialysis (HD; n = 8). The study was divided into a 3-month observation period, and a 3-month treatment period during which patients received 20 mg/kg per day of L-carnitine given orally. Clinical, biochemical, and hematological data were collected every 3 months. FC levels were measured in plasma and peritoneal dialysate by tandem mass spectrometry. There were no statistically significant changes in lipid levels, hemoglobin, or rhEPO requirements during the course of the study. Fifteen patients (13 PD, 2 HD) had plasma FC levels measured before and after treatment; FC levels increased from 32.1 ± 14.1 μmol/l to 80.9 ± 38.7 μmol/l (P < 0.001). In PD patients, dialysate FC losses increased from 106 ± 78 μmol/day at baseline to 178 ± 119 μmol/day after supplementation. Positive correlations between FC plasma levels and dialysate levels (R = 0.507) or daily excretion (R = 0.603) were found after treatment. In our case series, an oral dose of 20 mg/kg per day of L-carnitine restored FC levels and produced a positive carnitine balance with no significant effects on hematological parameters or lipid profile over a 3-month period. Prolonged treatment duration may be required to obtain significant results.