促红细胞生成素改善老年患者转子间骨折术后贫血和机制探讨

Effect of erythropoietin in the treatment of the elderly patients with post-surgery anemia of intertrochanteric femoral fracture and its mechanism

目的探讨促红细胞生成素治疗老年股骨转子间骨折患者术后贫血的临床疗效及相关机制。方法选择本院骨科2012年4月至2014年3月收治的120例老年股骨转子间骨折术后患者,采用随机数字表随机分为A组和B组两个治疗组,每组60例;同时将同期30例健康体检的老年人设为对照组。A组予口服富马酸亚铁(一日3次,每次0.2 g),持续治疗8周;B组在对照组的基础上加予皮下注射促红细胞生成素(rhEPO)制剂,每周3次、每次100 IU/kg,持续治疗8周。采用流式细胞检测评价治疗前后两组患者外周血中Th17细胞在外周血单个核细胞(PBMCs)中所占的比例;以蛋白免疫印迹法(Western-blot法)检测骨髓液中p-STAT3及SOCS3的表达水平,同时观察两组患者不良事件发生率。结果治疗后两治疗组组患者血红蛋白、红细胞压积均有改善,与治疗前比较差异有统计学意义(P<0.05),其中B组改善幅度较A组显著(P<0.05)。外周血Th17细胞在PBMCs中所占的比例,两治疗组治疗前较对照组显著增高,且差异有统计学意义(P<0.05);治疗后,两治疗组显著下降,但仍高于对照组,但与A组比较B组降低更为显著(P<0.05);A组和B组治疗后p-STAT3和SOCS3显著改善,且与A组相比,B组改善趋势更为显著(P<0.05)。结论促红细胞生成素能显著改善老年患者转子间骨折术后贫血症状,可能通过抑制STAT3信号通路磷酸化和促进SOCS3表达发挥治疗作用。

objective To explore the clinical effect of erythropoietin in the treatment of elderly patients with post-surgery anemia of intertrochanteric femoral fracture and to discuss related mechanism. Methods A total of 120 cases of elderly patients, who received intertrochanteric femoral fracture surgery and cured in our hospital orthopaedics dept between April 2012 - March 2014, were randomly divided into treatment group A and treatment group B （60 cases in each group）. 30 cases of healthy elderly in corresponding period were set as control group. Treatment group A took oral ferrous fumarate 0.2 g, tid, for 8 weeks; Treatment group B with subcutaneous injection of erythropoietin （rhEPO） 100 IU/kg on the basis of treatment group A, 3 times per week, continued for 8 weeks. The proportion of peripheral blood Th17 cells in the peripheral blood mononuclear cells （PBMCs） were detected by flow cytometry for both two groups of patients before and after treatment. The expression of p-STAT3 and SOCS3 in bone marrow fluid were detected by protein immunoblot method （Western blot method）. The occurrence rates of adverse events in both groups were observed. Results Hemoglobin, hematokrit in both two groups were improved after treatment, with statistical differences （P〈0.05）. The proportions of peripheral blood Th17 cells in PBMCs in both treatment groups were higher than the control group before treatment, with statistical significancedifferences （P 〈 0.05）. After treatment, the peripheral blood Thl7 cell percentage in treatment group B was still higher than the control group, but significantly lower than the treatment group A （P〈0.05）. The p-STAT3 and SOCS3 levels in both treatment groups improved after treatment. Conclusion Erythropoietin can improve post-surgery anemia of intertrochanteric femoral fracture through the inhibition on STAT3 signaling pathway.