重组人促红细胞生成素(rhEPO)在老年慢性病贫血(AcD)中治疗效果的评价及疗效的预测

Evaluation and prediction of response to recombinant human erythropoietin(rhEPO)in anemia of chronic disease(ACD)with senile patients

目的在32例年龄在60岁以上的慢性病贫血（anemia of chronic disease,AcD）患者中，应用重组人促红细胞生成素（recombinant human erythropoietin,rhEPO）治疗8周后测观察贫血改善情况，并筛选出具有较高临床意义的预测参数。方法32名AcD老年患者应用rhEPO治疗8周，8周内血红蛋白（hemoglobin，Hb）上升20g／L设为治疗有效。选用血清EPO水平、Hb、网状红细胞计数（reticulocyte count, Ret）、总铁结合力（total iron binding capacity,TIBC） 、血清铁（serum iron，SI）、血清铁蛋白（serum ferritin serum，SF）、可溶性转铁蛋白受体（serum transferrin receptor, sTfR）作为观测指标，观察患者8周时血红球蛋白的改变并进一步统计分析其与各观测指标变化之间的关系。结果32例老年AcD患者应用rhEPO治疗8周后Hb升高，SI、LgSF下降，sTfR升高（P〈0．05）。20例患者8周时获得预期疗效，多元回归分析提示rhEPO治疗8周后Hb改变与LgEPO及基线sTfR水平呈负相关（P〈0．05）。根据设定的评价方法将32例患者分为rhEPO治疗有效组及治疗无效组，绘制sTfR及LgEPO的受试者工作特征曲线（receiver operating characteristic curve, ROC曲线）并计算曲线下面积（area under the curve,AUC），后者具有统计学意义并且AUC更大（AUC为0．81，P〈0．05，95％CI：0．627～0．993），并通过最大Youden指数寻找到最佳诊断点为EPO≤58mIU／mL。如患者EPO≤58mIU／mL，可预测其能获得较好的治疗效果。结论rhEPO在老年慢性病贫血中可取得较好的治疗效果，患者的EPO水平是具有较高临床意义的预测参数。

Objective To observe the therapeutic effects of 32 senile patients with anemia of chronic disease （AcD） who received the treatment of recombinant human erythropoietin （rhEPO）, and to filtrate the best predictive value of various parameters. Methods rhEPO was applied for 8 weeks and its effectivity was defined as Hb increase ≥ 20 g/L. The level of serum EPO, hemoglobin （Hb）, reticulocyte count （Ret）, total iron binding capacity （TIBC）, serum iron （SI）, serum ferritin serum （SF） and serum transferrin receptor （sTfR） were measured. We observed the therapeutic effects andexamined the predictive value of various parameters. Results By 8-week treatment, Hb and sTfR levels were increased,SI level and LgSF were decreased （P〈0.05）. Twenty cases achieved effective treatment. Multiple regression analysis indicated that Hb level change was negatively correlated with baselines of LgEPO and sTfR. By prior standard, all patients were divided into effective group or noneffective group. We tried to draw receiver operating characteristic curve （ROC curve） sTfR and LgEPO, and to count the area under curves （AUC）. AUC LgEPO was bigger （AUC： 0. 81, P〈0.05, 95% CI：0. 627- 0. 993） and the cutoff was EPO≤58 mIU/mL by the largest Youden exponent. The serum EPO≥58 mIU/mL may predict good response to rhEPO treatment. Conclusions rhEPO treatment can obtain good therapeutic effects in senile patients with AcD and the level of serum EPO has the best predictive value of various parameters.