重组人促红细胞生成素小剂量长疗程在高龄慢性病贫血中的应用

Clinical research on low dose,long course treatment of erythropoietin(rhEPO) in advanced age undered anemia of chronic disease

目的观察皮下注射重组人促红细胞生成素(rhEPO)治疗高龄慢性病贫血(ACD)的剂量、疗程及安全性。方法将南京军区总医院干部病房确诊为ACD的146例高龄患者,按rhEPO使用剂量、疗程分为小剂量组82例和常规组64例,小剂量组应用rhEPO 3000U,皮下注射;常规组应用rhEPO 10 000U,皮下注射,2～3次/周。根据血红蛋白变化调整rhEPO的使用频次,保持血红蛋白110～120g/L。观察2组纠正ACD效果、使用疗程以及不良反应发生率。结果治疗后,2组患者血红蛋白均达到120g/L,调整rhEPO使用频次,长期治疗可保持血红蛋白110～120g/L。小剂量组5例发生轻度不良反应,常规组14例发生不能耐受的不良反应而停药,2组不良反应发生率比较差异有统计学意义(Ρ<0.05)。结论应用小剂量rhEPO能平稳有效纠正高龄ACD,对基础疾病无法治愈或好转的高龄ACD患者,小剂量、长疗程补充rhEPO,能安全、有效地维持患者血红蛋白水平。

Objective To observe the dosage ,course of treatment, and safety of erythropoietin used in treating elderly patients with anemia of chronic disease （ACD）. Methods Randomly divide the elderly patients with anemia of chronic disease （ACD）into two groups： small dose group and routine therapy group. The dose of rhEPO applied in small dose group was 50u per kilogram per day. The dose of routine therapy group was 150u per kilogram per day. The frequency of rhEPO applied is 2 to 3 times a week. Monitor the level of hemoglobin （Hb）and regulate the frequency of rhEPO applied according to the pathogenetic condition of patients＂ and the change of hemoglobin （Hb）. Maintain the concentration of Hb to 110 to 120 gram per liter. Observe the redress effect of ACD, course of treatment and the incidence rates of adverse reaction of the two groups. Results All patients＂ Hb in both groups reached 120 gram per liter. Continuing the treatment through regulated frequency of rhEPO applied, and were maintained at retained 110 to 120 gram per liter through continued treatments and regulated frequency of rhEPO applied. 5 cases of small dose group had light adverse reactions. 14 cases of routine therapy group stopped treatment because of intolerance. The difference of the two groups had statistical significance （P〈0.05）. Conclusions EPO of small dose could redress ACD placidly and effectively. To the elderly patients with basic disease who cann＇t improve or be eured,EPO of small dose and used through long course of treatment could maintain the concentration of Hb salty and efficiently.