非透析慢性肾脏病患者的贫血管理  

Management of anemia for patients with non-dialytic chronic kidney disease

作　　者：刘莉[1] 吕继成[1] LIU Li;LYU Ji-cheng(Department of Nephrology,First Hospital of Peking University,Beijing 100034,China)

机构地区：[1]北京大学第一医院肾内科,北京100034

出　　处：《中国实用内科杂志》2020年第11期895-898,共4页Chinese Journal of Practical Internal Medicine

摘　　要：肾性贫血是慢性肾脏病(CKD)患者常见的并发症,能导致病死率的增加。贫血的管理是CKD患者管理中的重要组成部分。多种因素参与了肾性贫血的发生,促红细胞生成素(EPO)相对不足是重要因素之一。肾性贫血的治疗经历了最早期的输血治疗阶段,在20世纪80年代末进入到EPO联合铁剂的治疗阶段,但仍然有相当部分患者表现为EPO低反应性,最常见的原因是铁缺乏,其次是合并炎症和感染。低氧诱导因子-脯氨酰羟化酶抑制剂(HIF-PHI)的诞生开启了肾性贫血治疗的新纪元。HIF-PHI与传统治疗手段不同,它可以通过稳定低氧诱导因子(HIFs)调控EPO基因的表达,改善铁的代谢,尤其适用于炎症状态的患者。Anemia is a common complication for patients with chronic kidney disease(CKD)and contributes to increased morbidity and mortality.Management of anemia is an important component of integrative therapy for CKD.Multiple factors are involved in the development of renal anemia.One of the important factors is the relative deficiency of erythropoietin(EPO).In earlier stages,blood transfusion was the main treatment for renal anemia.Since the 1980 s,application of EPO combined with supplement of iron has become the alternative treatments.However,a considerable number of patients fails to reach the target hemoglobin level and manifested hyporesponsiveness to EPO.The most common reason is iron deficiency,followed by inflammation and infection.The birth of hypoxia inducible factor-prolyl hydroxylase inhibitor(HIF-PHI)is a milestone in the treatment of renal anemia.Differing from the conventional treatments,HIF-PHI can regulate the expression of EPO gene by stabilizing hypoxia inducible factors(HIFs)and improve iron metabolism,especially suitable for patients with inflammatory state.

关 键 词：慢性肾脏病 肾性贫血 促红细胞生成素 低氧诱导因子-脯氨酰羟化酶抑制剂 

分 类 号：R556[医药卫生—血液循环系统疾病]