重组人促红细胞生成素治疗肿瘤相关性贫血及其与血清促红细胞生成素、转铁蛋白受体关系的临床研究  

Clinical Study of Treatment Using rHuEPO and Combined Detection of sEPO and sTfR in Cancer-related Anemia

作　　者：傅爱林[1] 沈文香[1] 汪小葛[2] 

机构地区：[1]江苏大学附属昆山医院血液肿瘤科,江苏昆山215300 [2]江苏大学附属昆山医院检验科,江苏昆山215300

出　　处：《中国血液流变学杂志》2014年第1期76-80,146,共5页Chinese Journal of Hemorheology

摘　　要：目的：探讨肿瘤相关性贫血（CRA）患者血清促红细胞生成素（sEPO）及血清转铁蛋白受体（sTfR）水平的测定在重组人促红细胞生成素（rHuEPO）联合铁剂治疗CRA中的指导意义。方法根据治疗前sEPO水平分成A组（sEPO≤200 mU/mL）和B组（sEPO＞200 mU/mL）、治疗前骨髓可染铁检查分成缺铁组和不缺铁组。分别采用ELISA双抗体法和放射免疫分析法测定sTfR、sEPO水平。入组病例全部予以rHuEPO治疗，缺铁组联合铁剂补充并进行疗效观察和结果分析。结果A、B两组患者治疗后血红蛋白（Hb）和红细胞压积（HCT）较治疗前均有显著改善，差异有统计学意义（A组：P＜0.01；B组：P＜0.05）。A组患者变化幅度较B组大，但变化幅度两组比较差异无统计学意义（P＞0.05），CRA缺铁亚组中联合治疗后4周时Hb、HCT有所升高，sTfR水平呈下降趋势，但3项指标较治疗前比较差异无统计学意义（P＞0.05）；随着铁储备的增加，治疗8周后各指标较治疗前比较差异有统计学意义（P＜0.01），rHuEPO单独或联合铁剂治疗CRA疗效确切；治疗前CRA缺铁组、单纯缺铁性贫血（IDA）组sTfR水平明显高于CRA不缺铁组和正常对照组，差异有统计学意义（P＜0.01），sTfR水平测定与骨髓可染铁检查在诊断铁缺乏方面具有一致性；直线相关性分析显示sEPO水平与Hb值之间两者呈负相关（P＜0.01，r=-0.8632）；同时发现sTfR水平也随Hb值提升而下降，但仅缺铁组相关性分析结果显示两者呈负相关（P＜0.05，r=-0.6413）。CRA患者的sEPO与sTfR水平之间无显著相关（P＞0.05，r=0.2913），亚组分析同样也显示无相关性。结论联合检测sEPO和sTfR在CRA患者诊断和鉴别诊断贫血病因中可提供重要的实验依据以指导贫血的个体化治疗。Objective To study the relationship between the levels of serum erythropoietin (sEPO) and serum transferrin receptor (sTfR), and to provide guideline for treatment with recombinant human erythropoietin (rHuEPO) combined with iron preparation in patients with cancer-related anemia (CRA). Methods The level of sTfR was detected by enzyme-linked immunosorbent assay (ELISA) and sEPO by immunoradiometric assay. The CRA patients were assigned into Group A (pretreatment sEPO≤200 mU/mL) and B (pretreatment sEPO>200 mU/mL), subdivided into status:iron deficiency anemia (IDA) and iron normal. All patients received subcutaneous dosage (10,000 IU/d three times a week) of domestic rHuEPO for four consective weeks. Therapeutic effects were then observed and analyzed. Results The Group B patients showed less statistically significant change from baseline Hb and HCT (P<0.05), compared with Group A, where an increased in Hb and HCT levels were marked evidenced (P<0.01). rHuEPO only or combined with iron preparation demonstrated encouraging outcome in patients whatever CRA alone or with IDA. sTfR was distinctly increased in CRA with IDA group and IDA alone group, manifesting statistically difference compared with CRA with non-concurrent iron deficiency and normal controls. A negative linear correlation was found between the level of sEPO and Hb in patients with CRA, P<0.01, r=-0.8632. The level of sTfR declined along with the ascent of Hb value. There existed negative linear correlation between the levels of Hb only in the CRA with IDA group, P<0.05, r=-0.6413. No correlation was found between the levels of sEPO and sTfR in any group, P>0.05, r=0.2913. Conclusion Combined detecting of sEPO and sTfR showed benefits for diagnosis and differential diagnosis, and provided reliable basis for identifying patients with CRA indicative of additional iron treatment.

关 键 词：肿瘤相关性贫血 促红细胞生成素 血清转铁蛋白受体 

分 类 号：R556.9[医药卫生—血液循环系统疾病] R730.6[医药卫生—内科学]