类风湿性关节炎贫血血清促红细胞生成素水平的临床研究

Clinical study of serum erythropoietin in anemia of rheumatoid arthritis

目的 研究促红细胞生成素 (EPO)在类风湿性关节炎 (RA)贫血发生机制中的作用 ;探讨重组人EPO(rhuEPO)在RA贫血治疗中的适应证。方法 采用美国Amgen公司提供的试剂盒测定了 40例RA贫血患者血清EPO(s EPO)的水平 ,分析其与血红蛋白水平的相关性。结果 RA贫血患者s EPO水平 5 2 .0 (11.2～2 16 .0 )U/L明显高于正常对照 4.8(3.3～ 46 .9)U/L及RA非贫血患者 7.2 (0 .6～ 2 0 .7)U/L ,但低于IDA患者 145 .6 (2 .6～ 36 6 .0 )U/L(P <0 .0 0 1) ;RA贫血伴缺铁组、RA贫血不伴缺铁组和IDA组 3者血红蛋白 (Hb)与s EPO呈对数负相关 (P <0 .0 1) ,3条回归线的相关性、斜率差异无统计意义 (P >0 .0 5 ) ,但其中RA贫血伴缺铁组截距低于IDA组 (P <0 .0 5 ) ,高于不伴缺铁组 (P <0 .0 5 ) ;IDA患者O/P比值置信区间为 0 .82～ 1.19。结论 RA贫血存在s EPO相对缺乏 ,s EPO对贫血反应迟钝 ;RA贫血患者s EPO水平个体差异大 ,建议根据O/P值的大小评估rhuEPO的可能疗效 ;RA贫血伴缺铁患者于治疗时应首先选用铁剂 ,而非rhuEPO。

Objective To investigate the role of EPO in the pathogenesis of anemia of RA, and define the indication for of rhuEPO treatment. Methods By assessing the serum EPO(s EPO)level in 40 anemic RA patients; and analyzing the relation between s EPO and the Hb level. Results s EPO levels in anemia of RA(52.0,11.2～ 216.0 U/L) were significantly higher than those of normal (4.8,3.3～46.9 U/L) and non anemic rheumatoid patients (7.2, 0.6～20.7 U/L), but lower than those of IDA patients (145.6, 2.6～236.6 U/L). There was a significant linear correlation between Hb and logEPO in these cases and in the control group. There had been no difference in regression slope and linear correlation ( P >0.05), but y intercept of RA with iron deficiency was higher than that in RA without iron deficiency but lower than that by IDA ( P <0.05). Observed/Predicted (logEPO) ratio (O/P ratio) was found at 95% confidence range of O/P ratio of IDA (0.82～1.19). Conclusion s EPO level is relatively deficient in anemia of RA. The level of s EPO in RA varies greatly, hence when using and evaluating the effect of rhuEPO in anemia of RA, s EPO level must be measured and O/P ratio (to equally anemic individuals of IDA) calculated. In these anemic RA patients with iron deficiency, iron preparation should be given first and not rhuEPO.(Shanghai Med J, 2000,23∶267 269)