红细胞生成刺激因子低反应的原因分析及处理策略

The etiology and management strategy of low responsiveness to erythropoiesis stimulatory agent

贫血是慢性肾脏病(chronic kidney disease,CKD)患者常见的并发症。红细胞生成素(erythropoietin,EPO)的使用明显改善了CKD患者贫血状态,但仍有5%~10%的患者尽管使用了较大剂量EPO,血红蛋白水平仍不能达标,临床考虑存在红细胞生成刺激剂(erythropoiesis stimulatory agent,ESA)低反应性。目前认识的导致ESA低反应性常见的原因有铁缺乏、炎症或感染、严重的继发性甲状旁腺功能亢进、不充分透析、抗体介导的纯红细胞再生障碍性贫血等。临床应按诊断流程明确导致ESA低反应性的原因,给予针对性治疗。

Anemia is a common complication of chronic kidney disease(CKD).Erythropoietin(EPO)significantly improves the anemia status of CKD patients.However,about 5~10%of the patients failed to reach the required hemoglobin level despite the use of a large dose of EPO,which is clinically considered to have low responsiveness to erythropoietin stimulating agent(ESA).According to the recent understanding,iron deficiency,inflammation and infection,severe secondary hyperparathyroidism,inadequate dialysis,antigen-mediated pure erythrocyte aplastic anemia,are the complications leading to low responsiveness to ESA.Clinically,regular diagnostic processes should be conducted to find out the cause of this disease situation and the appropriate management.