大剂量rHuEPO对肾性贫血患者血液和骨髓红系作用研究.docVIP

大剂量rHuEPO对肾性贫血患者血液和骨髓红系作用研究 　　[摘要] 目的：探讨应用大剂量重组人促红细胞生成素（rHuEPO）治疗肾性贫血的效果及机制。方法：对68例处于慢性肾脏病（CKD）3~5期的贫血患者给予佳林豪12 000 IU皮下注射，每周1次，连续12周，同时补充铁剂、叶酸和维生素B12；取血检测未成熟网织红细胞组分（IRF）、网织红细胞组分（Ret）、红细胞压积（Hct）、红细胞（RBC）、血红蛋白（Hb），并行骨髓穿刺进行骨髓显微图像分析，部分骨髓标本行电镜观察，观察治疗前后骨髓形态学变化，评价治疗效果。结果：治疗过程中大部分患者在EPO注射48 h后IRF、Ret升高（P0.05），IRF升高更为显著，且IRF在给药前和给药48 h后的数值无重叠区，1周后IRF、Ret进一步升高，12周时IRF、Hct、Ret、RBC、Hb均比用药前显著增高，骨髓红系增生较治疗前明显活跃，各类幼红细胞比率及总红系所占百分数（E）均显著升高，其中以晚幼红细胞增生最为明显。结论：大剂量rHuEPO治疗肾性贫血效果显著，IRF可成为肾性贫血患者应用rHuEPO后早期疗效监测的有效指标。 　　[关键词] 重组人促红细胞生成素；肾性贫血；红细胞系；未成熟网织红细胞组分 　　[中图分类号] R556[文献标识码]A [文章编号]1673-7210（2009）06（c）-015-03 　　 　　Effect of high dose rHuEPO on blood and bone marrow erythrocytic series of patients with renal anemia 　　GUO Zhentao, XIAO Qing, LI Xiangling, CHEN Jing 　　(Department of Nephrology, the Affiliated Hospital of Weifang Medical College, Weifang261031, China) 　　[Abstract] Objective: To study the effect and mechanism of high dose rHuEPO in the treatment of renal anemia. Methods: 68 patients with renal anemia and 3-5 stage CKD received 12 000 IU per week of Jialinhao by hypodermic injection for 12 weeks, meanwhile, they were administered with folic acids, vitamin B12 and chalybeates. A sample of blood was obtained to test IRF, Ret, Hct, RBC and Hb, after that, bone marrow puncture and bone marrow micrograph analysis were performed. A part of bone marrow samples were observed by electron microscope. The change of bone marrow morphology before and after treatment was observed, and the therapeutic effect was analyzed. Results: 48 h after treatment, most of the patients had a marked improvement in IRF and Ret (P＜0.05), and IRF showed a more significant increase. Moreover, the value before treatment and 48 h after treatment of IRF had no overlap; IRF and Ret were further increased after 1 week; after 12 weeks IRF%, Hct, Ret, RBC and Hb were significantly increased than before treatment, bone marrow erythrocytic series proliferation was more active than that before treatment, each