复方中药合剂对肾性贫血患者红细胞系及铁代谢的影响

Effect of Mixture of compound Chinese Herbal Medicine on Erythrocytic Series and Iron Metabolism in Patients with Renal Anemia

目的观察使用复方中药合剂治疗肾性贫血对患者红细胞系及铁代谢的影响。方法对69例肾性贫血患者给予复方中药合剂治疗连续8周,同时补充铁剂、叶酸和维生素B_(12);在治疗前和治疗8周后分别取血测促红细胞生成素(erythropietin,EPO)及血清转铁蛋白受体(soluble Transferrin Receptor,sTfR)血清浓度,并行骨髓穿刺进行骨髓显微图像分析和铁染色、部分骨髓标本行电镜观察,在治疗前及治疗后每2周分别取血测RBC,Hb,HCT,Ret%和SI,SF水平;观察治疗前后骨髓形态学变化,并对骨髓增生情况、sTfR、E%、各类幼红细胞比率、G/E、外铁、铁粒幼细胞百分数等进行自身对照分析。结果①患者在治疗后2周Ret%,RBC,Hb,HCT等开始上升,8周时比用药前有显著增高(P<0.01),总有效率89.85%.②治疗前骨髓显微图像4例(8%)示骨髓增生减低,可见棘细胞和环状红细胞,电镜下可见中幼红细胞核周间隙增宽,晚幼红细胞的胞膜厚薄不均匀;治疗后骨髓红系增生较治疗前明显活跃,各类幼红细胞比率及E%均显著升高(P<0.01),其中以晚幼红增生最为明显。③治疗后sTfR显著升高、而其它铁指标均明显降低。结论①对慢性肾脏疾病3～5期的患者给予复方中药合剂治疗可有效地刺激骨髓红系增生,证实该中药合剂治疗肾性贫血疗效显著。②该中药合剂治疗后红细胞形态有明显改善。③sTfR作为一种新的铁参数,不仅准确地反映机体铁贮存状况,而且也反映机体骨髓红细胞的增殖活性。

Objective To investigate the effect of mixture of compound Chinese herbal medicine on erythrocytic series and iron metabolism in patients with renal anemia. Methods Sixty-nine patients with renal anemia received treatment for 8 weeks, meanwhile they took folic acids,vitamins BI2 and ehalybeates. Bone marrow aspiration was performed before the treatment and after 8-week treatment respec- tivly. The variation of erythroid percent （ E% ） , sideroblast counts, RBC, Hb, HCT, Ret counts, sTiR, serum ferritin and serum iron before and after the therapy and their correlation were analyzed. Results ①After the therapy,the E% ,RBC, Hb,HCT and Ret count increased significantly. The total efficiency was 89.85% in 69 patients. ②Bone marrow analysis showed that the percent of low proliferation marrow was 8%. After therapy, the proliferation state of bone marrow erythroid cells was elevated. ③After therapy marrow iron stain, sideroblast counts, serum ferritin and serum iron decreased significantly,but the sTiR level increased obviously. Conclusions ①Mixture of compoud Chinese herbal medicine is effective in treatment of renal anemia,with the expansion of the red cell mass. ②After the therapy, morphous of RBC has improved obviously. ③sTiR is a new iron parameter that not only reflects iron store status of patients, but also reflects erythropoietic activity of bone marrow in patients with renal anemia.