Bosman D R, Winkler A S, Marsden J T, Macdougall I C, Watkins P J
King's Diabetes Centre, King's College Hospital, London, UK.
Diabetes Care. 2001 Mar;24(3):495-9. doi: 10.2337/diacare.24.3.495.
The normochromic normocytic anemia of erythropoietin (EPO) deficiency is recognized in advanced renal failure but not in early renal disease. The aim of this study was to determine whether anemia with EPO deficiency is found in type 1 diabetic patients with diabetic nephropathy in the absence of advanced renal failure and to compare them with patients with nondiabetic renal disease of similar severity.
A total of 27 type 1 diabetic patients with diabetic nephropathy (DN), defined as having persistent proteinuria (mean 1,086 mg/day [CI 120-5,1901), a serum creatinine < or = 180 micromol/l, and retinopathy, were compared with 26 nondiabetic patients with glomerulonephritis (GN) and persistent proteinuria (1,874 mg/day [349-5,005]). The Hb concentration, red cell indexes, and serum EPO levels were measured, and other causes for the anemia were excluded. The EPO values were compared with a normal reference range obtained from nondiabetic patients with a microcytic anemia. The DN patients were tested for signs of diabetic peripheral and autonomic neuropathy.
We found that 13 of the 27 DN patients were anemic (Hb 10.6 +/- 0.9 g/dl) in marked contrast to none of the GN patients (Hb 13.7 +/- 1.4 g/dl, P < 0.005). In the DN group, serum EPO concentrations failed to increase in response to anemia compared with the response seen in patients with microcytic anemia. Thus, the anemia of the DN group was associated with EPO deficiency. The anemic DN patients showed evidence of more severe proteinuria and diabetic neuropathy than the nonanemic DN patients.
Anemia associated with EPO deficiency can occur early in DN before the onset of advanced renal failure, but does not normally occur in nondiabetic renal disease of similar severity. The pathogenesis requires elucidation.
促红细胞生成素（EPO）缺乏所致的正细胞正色素性贫血在晚期肾衰竭中已得到公认，但在早期肾脏疾病中尚未被认识。本研究的目的是确定在无晚期肾衰竭的1型糖尿病肾病患者中是否存在EPO缺乏性贫血，并将其与病情严重程度相似的非糖尿病肾病患者进行比较。
共有27例1型糖尿病肾病（DN）患者，定义为持续性蛋白尿（平均1086mg/天[可信区间120 - 5190]）、血清肌酐≤180μmol/l且有视网膜病变，与26例非糖尿病肾小球肾炎（GN）且有持续性蛋白尿（1874mg/天[349 - 5005]）的患者进行比较。测量血红蛋白浓度、红细胞指数和血清EPO水平，并排除贫血的其他原因。将DN患者的EPO值与从非糖尿病小细胞贫血患者获得的正常参考范围进行比较。对DN患者进行糖尿病周围神经病变和自主神经病变体征的检测。
我们发现27例DN患者中有13例贫血（血红蛋白10.6±0.9g/dl），这与GN患者无一例贫血（血红蛋白13.7±1.4g/dl，P<0.005）形成显著对比。在DN组中，与小细胞贫血患者相比，血清EPO浓度对贫血未出现相应升高。因此，DN组的贫血与EPO缺乏有关。贫血的DN患者比非贫血的DN患者表现出更严重的蛋白尿和糖尿病神经病变。
与EPO缺乏相关的贫血可在DN早期即晚期肾衰竭发生之前出现，但在病情严重程度相似的非糖尿病肾病中通常不会出现。其发病机制有待阐明。
