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111.
《Annals of hepatology》2009,8(4):316-324
Background and Rationale. Anemia is a major side effect of combination therapy for chronic hepatitis C. In this study, severity, potential risk factors for and potential underlying mechanisms of anemia were evaluated.Patients and methods. 44 chronic hepatitis C patients on interferon-ribavirin treatment were included. Anemia-related parameters were measured before and during treatment. Potential changes in membrane phospholipids composition of erythrocytes of patients on anti-viral treatment and potentially increased erythrocyte susceptibility to osmotic or bile salt induced stress were explored.Results. Anemia was almost universal during treatment, with evidence of hemolysis. Decrease of Hb after six months of therapy was 2.1 ± O.I mmol/L (range -0.6-4.1). Higher pre-treatment Hb, highest ribavirin dose (1S-17.S mg/kg) and lower pre-treatment platelet level were independent risk factors for decrease of Hb. Serum erythropoietin levels increased during treatment with negative correlation to Hb levels at week 12 (r = -0.70, p = 0.002) and 24 (r = -0.72, p = 0.002). Erythrocyte membrane phospholipid composition did not differ between anemic patients and healthy controls. Also, resistance to osmotic or bile salt induced stress was normal in anemic patients. Phosphatidylserine exposure at the outer membrane leaflet did not change upon 24 hrs ex vivo incubation with pharmacological ribavirin concentration.Conclusions. Anemia is almost universal during anti-HCV treatment. The extent of anemia correlates with pre-treatment levels of thrombocytes and Hb and with high ribavirin dosing. Although we found hemolysis as contributing factor, our data do not indicate that altered membrane phospholipids composition is an important factor in pathogenesis of anemia. 相似文献
112.
113.
M.E. Roque M.J. Sandoval M.C. Aggio 《International journal of laboratory hematology》2001,23(5):291-295
Serum erythropoietin (Epo) and soluble transferrin receptor (sTR) were measured in a locally defined reference population (n=100): healthy volunteers (n=50); iron‐ deficiency anaemia (n=41) and haemolytic anaemia (n=9) (β‐thalassaemia, n= 4; autoimmune, n=5). Our data demonstrated an inverse relationship between erythroid activity and Epo levels. The regression line between Ln Epo and haemoglobin (Hb) was highly significant: P < 0.0001, r2=0.8275, Ln Epo=8.5346–0.04275 Hb, confidence limit 95%. The mean observed/predicted (O/P) ratio of Ln (Epo) was 1.01 ± 0.11. We demonstrated that the serum Epo concentration in this particular population correlated consistently with clinical measures of erythropoietic activity. sTR, a new index of erythropoiesis, varied from 16.1 to 148 nmol/l, mean 62.0 nmol/l in the anaemic patients’ group. The relationship between Ln Epo and Ln sTR was highly significant: P < 0.0001. We conclude that locally defined regression analyses are crucial for correct data interpretation and can indicate whether or not Epo production is appropiate or inappropiate. Serial determinations of sTR could help in the assessment of response to therapeutic doses of Epo. 相似文献
114.
Antonio Macciò Clelia Madeddu Giulia Gramignano Carlo Mulas Eleonora Sanna Giovanni Mantovani 《The oncologist》2010,15(8):894-902
Advanced‐stage cancer patients often suffer from anemia that closely resembles the anemia of chronic inflammatory diseases characterized by specific changes in iron homeostasis and absorption. i.v. iron improves the efficacy of recombinant human erythropoietin (rHuEPO) in anemic cancer patients undergoing chemotherapy. We report the results of an open‐label, randomized, prospective trial aimed at testing the efficacy and safety of treatment with oral lactoferrin versus i.v. iron, both combined with rHuEPO, for the treatment of anemia in a population of 148 advanced cancer patients undergoing chemotherapy. All patients received s.c. rHuEPO‐β, 30,000 UI once weekly for 12 weeks, and were randomly assigned to ferric gluconate (125 mg i.v. weekly) or lactoferrin (200 mg/day). Both arms showed a significant hemoglobin increase. No difference in the mean hemoglobin increase or the hematopoietic response, time to hematopoietic response, or mean change in serum iron, C‐reactive protein, or erythrocyte sedimentation rate were observed between arms. In contrast, ferritin decreased in the lactoferrin arm whereas it increased in the i.v. iron arm. In conclusion, these results show similar efficacy for oral lactoferrin and for i.v. iron, combined with rHuEPO, for the treatment of anemia in advanced cancer patients undergoing chemotherapy. 相似文献
115.
Lesley Bennett Jill Woodford Lena Sderberg Samuel Corl Naomi Clyne 《Journal of Renal Care》2001,27(3):143-146
Aim: A Corporate Education Session was held to provide concrete strategies for overcoming several specific barriers in the daily nurse‐patient relationship that negatively affect the patient, nurse, or both, and to provide the latest information about best practice as it affects nurses in renal care. Methodology: The session was led by a moderator who presented three video case studies to the audience. Communication strategies for recognising and overcoming nurse‐patient communication barriers were presented. The audience expressed their views about each case study using voting pads, and a panel of experts addressed the comments of the audience and discussed guidelines for best practice in renal care. The panel comprised three experienced renal nurses, a senior nephrologist, and an expert in social interaction. Conclusions: Optimal treatment of patients with renal disease should include early treatment of anaemia, adequate levels of dialysis, and a multidisciplinary approach, responding to both the medical and the social needs of the patient. 相似文献
116.
Wang Mengjing Huang Bihong Tao Ye Zhang Weichen Chen Weisheng Huang Junwen Wang Hongying Zhang Minmin Chen Jing. 《中华肾脏病杂志》2018,34(12):909-916
Objective To observe the effects of three treatment methods on renal anemia in maintenance hemodialysis patients with hyperparathyroidism secondary to uremia and analyze the influencing factors of erythropoietin (EPO) dosage. Methods A total of 55 maintenance hemodialysis patients with secondary hyperparathyroidism at the hemodialysis center of Huashan Hospital affiliated to Fudan University from January 2015 to December 2016 were retrospectively divided into three groups according to different treatment methods, parathyroidectomy +forearm transplantation group (surgery group, n=16), cinacalcet treatment group (n=6), and calcitriol treatment group (n=33), respectively. The hemoglobin level and erythropoietin dosage were measured before treatment and in the 3rd month, the 6th month and the 12th month after treatment. The changes of hemoglobin and erythropoietin dosage in the three groups before and after treatment were observed, and the mixed effect model was used to analyze the difference of the change of hemoglobin and erythropoietin dosage among three groups. Multiple linear regression analysis was used to analyze the influencing factors of EPO dosage after one year. Results The levels of intact parathyroid hormone (iPTH) in the surgery group and the cinacalcet group before treatment were significantly higher than that in the calcitriol group (both P<0.05). In the 12th month after treatment, the levels of iPTH decreased significantly in the patients of surgery group and the cinacalcet group compared with those before treatment (both P<0.05). The levels of serum alkaline phosphatase, serum calcium and serum phosphorus in the surgery group also decreased significantly compared with those before treatment (all P<0.05). The mixed effect model analysis showed that the hemoglobin level of surgery group was on an upward trend after the treatment, and the overall level was significantly higher than cinacalcet and calcitriol treatment group (P=0.007). There was no significant difference in the dosage change of erythropoietin (EPO) in the three groups over time. However, the intra-group comparison of the mixed effect model showed that the dosage of EPO in the 12th month was significantly lower than that of before the treatment in surgery group (P=0.007). Multiple linear regression analysis showed that dialysis vintage (B=-0.064, P=0.012) and ferritin ≥ 500 μg/L (B=0.645, P=0.032) were independent influencing factors of EPO dosage. The longer the dialysis vintage, the less EPO dosage, and more EPO dosage were observed in patients with ferritin ≥ 500 μg/L. Conclusions Parathyroidectomy and forearm transplantation is more effective in reducing EPO dosage and improving renal anemia in maintenance hemodialysis patients with secondary hyperparathyroidism. Dialysis vintage and ferritin are independent influencing factors for the dosage of EPO. 相似文献
117.
目的探讨癌性贫血患者EPO生成及红系增生的变化,以及TNF、IFN等负调控细胞因子对EPO生成及红系增生的影响。方法对50例癌性贫血患者、15例癌症无贫血患者及对照组采用放射免疫法检测血清EPO水平,ELISA方法检测血清可溶性转铁蛋白受体(sTfR)、TNF-α、IFN-γ水平,用直线回归方法及相关分析定量分析体内EPO生成、红系增生情况及其与TNF-α、IFN-γ的关系。结果癌性贫血患者血清EPO水平为(23.11±10.00)IU/L,明显低于同等程度贫血的缺铁性贫血患者的(43.00±22.00)IU/L(P〈0.01);实测值/预估值(O/P)EPO为0.88(0.54~1.10),明显低于对照组及癌症无贫血患者,后二者之间的O/PEPO差异无统计学意义。癌性贫血患者的血清sTfR水平(30.8±16.95)nmol/L,高于健康对照组的(17.82±6.76)nmol/L,而低于溶血性贫血患者的(65.75±29.12)nmol/L,差异均有统计学意义(P〈0.05);O/PsTfR为0.89(0.57~1.22),明显低于对照组及癌症无贫血患者,后二者之间O/PsTfR差异无统计学意义。正常情况下存在于log(EPO)与血红蛋白浓度之间以及log(sTfR)与血红蛋白浓度之间的反比关系消失。癌性贫血患者血清TNF-α、IFN-γ水平分别为(25.75±26.71)ng/L、(50.49±42.12)ng/L,均显著高于正常对照组及癌症无贫血组。TNF-α、IFN-γ水平与血红蛋白浓度之间呈负相关关系。TNF-α与O/PEPO、O/PsTfR之间呈负相关。血清IFN-γ水平与O/PEPO之间无相关关系,与O/PsTfR呈负相关。结论TNF-α、IFN-γ等负调控因子的作用下,内源性EPO对贫血的反馈性增生相对不足,以及骨髓红系对EPO的反应性增生相对不足参与癌性贫血的发病机制。 相似文献
118.
119.
目的通过观察慢性肾衰竭大鼠肾移植前后骨髓红系祖细胞的红细胞生成素受体(EPOR)的变化及与肾功能和贫血的关系,探讨红细胞生成素受体(EPOR)抑制在肾性贫血中的作用。方法以慢性肾衰竭(CRF)大鼠作为受者行同种异体肾移植术模拟人类肾移植。模型建立后RT-PCR法测定假手术组、CRF组和肾移植后不同时间大鼠骨髓红系祖细胞EPORmRNA表达的变化,WesternBlot分析EPOR蛋白质含量变化趋势,同时作EPORmRNA、EPOR蛋白质含量、Scr、Hb之间的相关性分析。结果CRF模型在5/6肾切除后90d时成功,接受肾移植后其血清肌酐和尿素氮迅速下降。CRF时EPORmRNA的表达和EPOR蛋白质含量较正常对照组明显降低,肾移植术后第7d开始二者明显升高,14d时恢复正常。相关性分析显示,EPORmRNA、EPOR蛋白含量、血红蛋白(Hb)均与血清肌酐呈显著性负相关,而EPORmRNA、EPOR蛋白含量与Hb呈显著性正相关。结论大鼠接受肾移植,尿毒症毒素完全清除后EPORmRNA及EPOR蛋白质含量显著增加至正常水平,提示EPOR抑制是引起肾性贫血的重要机理之一。 相似文献
120.
J. S. Malyszko J. Malyszko K. Pawlak M. Mysliwiec 《International Journal of Clinical & Laboratory Research》1996,26(3):199-202
Erythropoietin treatment is known to correct anemia and to improve hemostasis. Since platelets may contribute to thromboembolic
complications, we assessed platelet aggregation in whole blood and platelet-rich plasma from chronically hemodialyzed patients
treated with erythropoietin and evaluated in vitro effects of this drug on aggregatory responses of uremic and normal platelets.
Recombinant human erythropoietin was given to uremic patients at a dose of 2.000 IU subcutaneously three times a week. Platelet
aggregation in whole blood and platelet-rich plasma was induced by collagen, ADP, arachidonic acid, and ristocetin. In uremic
patients, erythropoietin therapy resulted in an enhancement of platelet sensitivity to various agonists, particularly in platelet-rich
plasma, reaching values comparable to those of healthy volunteers. In vitro studies we were unable to show any direct effect
of erythropoietin, used at concentrations that occurred post intravenous administration, on platelet aggregation both in whole
blood and in platelet-rich plasma. 相似文献