重组人促红素的不同起始使用时间与早产儿贫血程度的关系

Prevention of Premature Infant Anemia by Recombinant Human Erythropoietin

目的观察重组人促红细胞生成素(rHu EPO)的不同起始应用时间与早产儿贫血程度的关系。方法将2004年7月至2006年11月收治的小早产儿(胎龄<34周,体重<1800g)41例随机分为早应用组(A组)(21例)和晚应用组(B组)(20例)。早应用组于生后7d内开始给rHu EPO 200 IU/(kg·次),皮下注射,隔日1次,每周3次,共3～6周;晚应用组于早产儿血红蛋白<140g/L时开始给rHu EPO 200 IU/(kg·次),皮下注射,隔日1次,每周3次,共3～6周。观察两组早产儿血红蛋白(Hb)、红细胞压积(Hct)、网织红细胞(Ret)的动态变化。结果两组早产儿生后Hb、Hct均逐渐下降,但早应用组下降明显小于晚应用组,经t检验,两组之间差异有统计学意义(P<0.05,P<0.01)。早应用组两周后Ret升高较晚用组明显,差异有统计学意义(P<0.01,P<0.05)。晚应用组有4例输血,早应用组无一例输血,经精确!2检验,差异有统计学意义(P=0.019)。结论早产儿在生后一周内血红蛋白正常时应用rHuEPO效果好,即早产儿早用rHuEPO对预防贫血有积极意义,出现贫血后再用可能意义不大。

Objective To determine the best application time of recombinant human erythropoietin （rHu EPO） in the prevention of premature infant anemia. Methods Forty one premature infants （34 weeks of gestation, body weight （1 800 g） were andomly assigned to two groups： Group A （n=21） receives rHu （subcutaneous injection with 200 IU EPO at 1 day interval, 3 times a week for 3 to 6 weeks） within 7 days after birth, and Group B （n=20） receives rHu （subcutaneous injection with 200 IU EPO, same schedule as Group A） only when the levels of hemoglobin （Hb） was lower than 140 g/L. The levels of Hb, hematocrit （Hct）, and reticulocyte counts （Ret） were monitored. Results All premature infants showed a declined in the value of Hb and Hct, and the declined in these values was slower in Group A infants （Hb, P〈0.05; Hct, P〈0.01 ）. Infants in Group A had a significantly higher Ret at the end of second week after treatment （P〈0.01 ,P〈0.05）. The need for blood transfusion was also reduced in Group A （0% vs 20%）（4 cases）of infants in Group B receiveing transfusion（P=0.019）. Conclusion Premature infant receiving rHu EPO had a normal Hb in the first week after treatment, rHu EPO may not be effective when the anemia was developed.