慢性肾功能衰竭患者红系祖细胞功能及贫血机制的研究

Function of erythroid precursors and the mechanism of anemia in chronic renal failure

用慢性肾功衰（ｃｈｒｏｎｉｃｒｅｎａｌｆａｉｌｕｒｅ，ＣＲＦ）患者透析前、透析后的各自混合血浆分别与ＣＲＦ患者及正常人骨髓红系祖细胞培养，测定血清红细胞生成素（ｅｒｙｔｈｒｏｐｏｉｅｔｉｎ，ＥＰＯ），放免法测定血清叶酸和铁蛋白，并计数外周血片异形红细胞数。结果表明：①未透析患者红系祖细胞在正常混合血浆培养下与正常对照无差别（Ｐ＞０．０５），②透析前、后的血浆均对红系祖细胞有抑制作用（Ｐ＜０．０５），③但未透、腹透和血透三组之间对红系祖细胞的影响无明显差别（Ｐ＞０．０５），④未透ＣＲＦ患者血清ＥＰＯ和叶酸均明显减少（Ｐ＜０．０１），⑤少数患者血清铁蛋白减低、外周血片异形红细胞数增高。提示：ＣＲＦ贫血患者血液中存在红系生成抑制因子，这些因子包括大、中、小三种分子。红系受抑和ＥＰＯ减少是ＣＲＦ贫血的主要原因，叶酸、铁缺乏及溶血可加重贫血。

Using the mixed plasma of patients with chronic renal failure(CRF)of predialysis first and then postdialysis ,we separately cultured the erythroid precursors of bone marrow of patients with CRF and of those of nomal persons. Then we assayed serum erythropoietin (EPO)with fetal mouse liver cells, folic acid( FA)and serum ferritin(SF)with radioimmunity and counted abnormal-shaped erythrocytes of the peripheral blood smear.The resultsareas follows:(1)The erythroid precursors of predialysis patients were notdifferent from those of the normalcontrol innormal plasma P>0.05);(2 )The plasma ofpredialysis or postdialysis could inhibit the growth of the erythroid precursorsP<0.0;(3 )The growth of the erythroid precursors was not different amongthethree groups of predialysis, peritoneal dialysis and hemodialysis( P>0.0;(4 )The concentra-tions of the serum EPO and FA of predialysis patients reduced obviously(P<0.01);(5 )The concentration of the SF of few patients decreased, and the amount of abnormal-shaped erythrocytes of the peripheral blood smear increased.It was suggested that there were some inhibitors of erythropoiesisin blood of anemic patients with CRF,which include big,medium ,and small moleculeThe inhibition of the erythropoiesis and EPO defi-ciency was the major cause of anemiaof CRF.But deficiency of FA and iron,and hemo-lysis might have made anemia more serious.