慢性病贫血的发病机制及诊断

The mechanism and diagnosis of anemia of chronic disease

慢性病贫血（ACD）是一种常见的临床并发症，可加剧原发疾病对身体的损伤，对原发疾病的治疗及预后带来不利影响。其发病机制包括促红细胞生成素（EPO）反应迟钝及红细胞寿命缩短、细胞网状内皮系统铁的摄取和滞留增加、红系祖细胞增殖受损及铁调素的负性铁调节作用。ACD的诊断主要是寻找原发疾病。其鉴别诊断主要依靠临床表现及实验室检查，除了骨髓铁染色，血清可溶性转铁蛋白受体（sTFR）及sTIR与血清铁蛋白对数的比值（sTFR／logSF）、红细胞指数、铁调素、生长转化因子（GDF）15可协助鉴别。

Anemia of chronic disease （ACD） is a common complication which can aggregate the injuries caused by primary diseases and result in negative effects on the treatment and prognosis of the primary diseases. Its mechanisms are complicated, including EPO delayed reaction and shortened life of red blood ceils, increased intake and detention of iron in the reticular system, and the productive impairment of progenitor red blood cell progenitors and negative regulation of hepcidin. The diagnosis of ACD depends on determination of primary diseases and the differential diagnosis depends on clinical manifestation and experiment tests. In addition to bone marrow iron staining, serum soluble transferrin receptor （ sTfR）, the ratio of sTfR and log serum ferritin （ sTFR/log SF） , erythrocyte indices, hepcidin, transforming growth fac- tor- 15 （TGF- 15） can be useful for identification.