Beneficial effect of atorvastatin on erythropoietin responsiveness in maintenance haemodialysis patients

Aim: To evaluate the effect of atorvastatin on erythropoietin responsiveness and whether this effect is mediated by C‐reactive protein (CRP) reduction in prevalent dyslipidemic, haemodialysis patients. Methods: We studied prospectively 33 stable, iron‐repleted haemodialysis patients with low‐density lipoprotein cholesterol (LDL) ≥2.58 mmol/L, who received 20 mg atorvastatin aiming to achieve the target of LDL <2.58 mmol/L, over a period of 9 months. Twenty‐five patients completed the study, 15 men, with mean age 66.1 ± 8.2 years. The duration of haemodialysis was 56.6 ± 63.1 months and 5/25 patients were diabetics. Total serum cholesterol, triglycerides, high‐density lipoprotein cholesterol, LDL, haemoglobin, albumin, intact parathyroid hormone, serum iron, ferritin, total iron binding capacity, CRP and weekly dose of erythropoietin/body weight/haemoglobin were analysed. Results: Twenty of the 25 patients (80%) achieved the goal of LDL <2.58 mmol/L. There was a significant decrease in total cholesterol (5.77 ± 0.88 to 4.16 ± 0.96 mmol/L, P < 0.001) and LDL (3.59 ± 0.77 to 1.94 ± 0.77 mmol/L, P < 0.001). Haemoglobin increased from 121 ± 11 to 126 ± 7 g/L (P < 0.05), while weekly dose of erythropoietin/body weight/haemoglobin decreased significantly from 8.34 ± 3.70 to 7.87 ± 3.11 IU/kg per haemoglobin (P < 0.05). CRP decreased not significantly from 7.0 ± 6.1 to 4.5 ± 2.2 mg/L. Conclusion: Dyslipidemia of haemodialysis patients was treated safely and effectively with atorvastatin, but a fifth of the patients failed to achieve the therapeutic target. Statin therapy resulted in a significant increase of haemoglobin levels and improvement of erythropoietin responsiveness without a significant reduction in CRP levels, suggesting that the beneficial effect of statins on erythropoietin responsiveness may be driven by a mechanism other than CRP reduction.     

IMMUNOGLOBULIN LEVELS IN CHILDREN WITH HOMOZYGOUS β-THALASSEMIA

Abstract. Patients with hereditary hemolytic anaemias have been known to have immunoglobulin alterations related to an increased susceptibility to infection. In the present series, immunoglobulins G, A and M have been estimated in 50 thalassemic children aged 10 months to 13 years. No significant difference was found in any of the immunoglobulins between patients and age-matched controls. No correlation could be shown between immunoglobulin levels and ( a ) the severity of anaemia, ( b ) the degree of hemosiderosis, and ( c ) the frequency of febrile infections per year. Against clinical impressions patients did not show any increased susceptibility to infections.     

全膝关节置换术中的髌骨表面置换——荟萃分析

背景：全膝关节置换术中的髌骨表面置换仍有争议。我们旨在通过对现有文献的分析来评估应用这一技术的治疗效果。 方法：搜集对比全膝关节置换术中施行与不施行髌骨表面置换的随机对照研究资料，对其进行荟萃分析。其中有意义的结果包括：再手术的例数、术后膝前疼痛的出现以及各种膝关节功能指数的改善。 结果：共分析了10项1223膝的研究结果。在术中施行髌骨表面置换研究结果中（研究间异质性评价，p〈0．01；Ⅰ^2=60％）再手术风险减少了4．6％（95％可信区间，1．9％～7.3％），意味着施行22例髌骨表面置换（95％可信区间，14～52个髌骨）才能防止1例再手术。髌骨表面置换使术后出现膝前疼痛的绝对风险减少了13.8％（95％可信区间，6．4％～21．2％），意味着施行7例髌骨表面置换可防止1例术后膝前疼痛的发生。对膝关节各种指数的改变仅有4项研究提供了足够的定量分析资料；基于这4项研究，膝关节评分平均数的改善没有显著性差异（标化均数差值为0．03；95％可信区间；-0．50～0．56）。 结论：现有证据显示髌骨表面置换降低了全膝关节置换术后再手术和出现膝前疼痛的风险。尽管研究资料的数量有限，但本结果有重要的临床意义。此外，仍需要精心设计的随机研究来进一步证明这一观点。 可信水平：治疗性研究，Ⅰ级。进一步可信度参见作者介绍。