Debska-Slizień A, Owczarzak A, Kunicka D, Lysiak-Szydłowska W, Rutkowski B
Department of Nephrology, Transplantology and Internal Medicine, Institute of Internal Medicine, Medical University of Gdańsk, Poland.
Int J Artif Organs. 2003 Jan;26(1):33-8. doi: 10.1177/039139880302600106.
Recombinant human erythropoietin (epoetin) is widely used for correction of anaemia in patients with chronic renal disease and its efficacy has been confirmed in numerous studies. Disturbances in carnitine metabolism may also contribute to the development of renal anaemia. Although increases in erythrocyte count (RBC) and changes in RBC metabolism during L-carnitine administration have been observed, supplementation with L-carnitine in anaemic hemodialysis patients is not routine. The aim of our study was to determine the influence of epoetin on hematological parameters and plasma carnitine profile in anaemic hemodialysis patients. 36 hemodialysis patients (22 men, 14 female, aged from 17 to 64 years, mean 43) and 30 healthy volunteers (12 men, 18 female, aged from 25 to 65 years, mean 40) were studied. Epoetin (Eprex, Janssen-Cilag) was administered subcutaneously for twelve months with the starting dose 2000 IU three times per week (range from 75 to 133, mean 102 +/- 21 IU/kg/week). The target hemoglobin (Hb) range at the time of the study was between 10-11 g/dL. Laboratory markers of hematological response, carnitine and iron status, were measured before epoetin administration and then controlled every three months. During epoetin treatment a significant increase in Hb concentration was observed (100% of patients responded to epoetin). In the third and six month of epoetin treatment, along with a significant increase in mean reticulocyte count and the highest increment of RBC count and Hb levels, probably due to increased erythropoiesis, a significant, transient decrease of mean total and free plasma carnitine levels was observed. This may suggest the utilisation of carnitine by a new RBC population. It also indicates that there is a need for L-carnitine in carnitine deficient maintenance hemodialysis patients particularily during erythropoiesis induced by epoetin treatment.
重组人促红细胞生成素（依泊汀）广泛用于纠正慢性肾病患者的贫血，其疗效已在众多研究中得到证实。肉碱代谢紊乱也可能导致肾性贫血的发生。尽管在给予左旋肉碱期间观察到红细胞计数（RBC）增加以及RBC代谢发生变化，但贫血血液透析患者补充左旋肉碱并非常规做法。我们研究的目的是确定依泊汀对贫血血液透析患者血液学参数和血浆肉碱谱的影响。研究了36例血液透析患者（22例男性，14例女性，年龄17至64岁，平均43岁）和30名健康志愿者（12例男性，18例女性，年龄25至65岁，平均40岁）。皮下注射依泊汀（益比奥，杨森-西拉格公司），为期十二个月，起始剂量为每周三次，每次2000国际单位（范围为75至133，平均102±21国际单位/千克/周）。研究时目标血红蛋白（Hb）范围为10 - 11克/分升。在给予依泊汀之前测量血液学反应、肉碱和铁状态的实验室指标，然后每三个月进行一次监测。在依泊汀治疗期间，观察到Hb浓度显著增加（100%的患者对依泊汀有反应）。在依泊汀治疗的第三个月和第六个月，随着平均网织红细胞计数显著增加以及RBC计数和Hb水平的最高增幅，可能是由于红细胞生成增加，观察到平均总血浆肉碱水平和游离血浆肉碱水平显著且短暂下降。这可能表明新的红细胞群体利用了肉碱。这也表明，尤其是在依泊汀治疗诱导红细胞生成期间，肉碱缺乏的维持性血液透析患者需要补充左旋肉碱。
