Ladas Spiros D, Polymeros Dimitrios, Pagonis Thomas, Triantafyllou Konstantinos, Paspatis Gregorios, Hatziargiriou Maria, Raptis Sotirios A
Gastroenterology Unit, 2nd Department of Internal Medicine, Athens University, Evangelismos Hospital, 23 Sisini street, 115 28 Athens, Greece.
World J Gastroenterol. 2004 Feb 15;10(4):586-9. doi: 10.3748/wjg.v10.i4.586.
Anaemia caused by acute upper gastrointestinal bleeding is treated with blood transfusion or iron, but patients usually face a two-month recovery period from post-haemorrhage anaemia. This prospective, randomised, open, pilot study was designed to investigate whether recombinant human erythropoietin (Epoetin) therapy accelerate haematocrit increase in the post-bleeding recovery period.
We studied hospitalised patients admitted because of acute ulcer bleeding or haemorrhagic gastritis, who had a haematocrit of 27-33% and did not receive blood transfusions. One day after the endoscopic confirmation of cessation of bleeding, they were randomised either to erythropoietin (20 000 IU Epoetin alfa subcutaneously, on days 0, 4 and 6) plus iron (100 mg im, on days 1- 6, (G(1)) or iron only (G(2)). Haematocrit was measured on days 0, 6, 14, 30, 45, and 60, respectively.
One patient from G(1) and two from G(2) were lost to follow-up. Therefore, 14 and 13 patients from G(1) and G(2) respectively were analysed. Demographic characteristics, serum iron, ferritin, total iron binding capacity, reticulocytes, and haematocrit were not significantly different at entry to the study. Median reticulocyte counts were significantly different between groups on day six (G(1): 4.0, 3.0-6.4 vs G(2): 3.5, 2.1-4.4%, P=0.03) and median haematocrit on day fourteen [G(1): 35.9, 30.7-41.0 vs G(2): 32.5, 29.5-37.0% (median, range), P=0.04].
Erythropoietin administration significantly accelerates correction of anemia after acute ulcer bleeding. The haematocrit gain is equivalent to one unit of transfused blood two weeks after the bleeding episode.
急性上消化道出血所致贫血通常采用输血或铁剂治疗，但患者从出血后贫血中恢复通常需要两个月时间。本前瞻性、随机、开放、试点研究旨在调查重组人促红细胞生成素（Epoetin）治疗是否能加速出血后恢复期血细胞比容的升高。
我们研究了因急性溃疡出血或出血性胃炎住院、血细胞比容为27%-33%且未接受输血的患者。在内镜确认出血停止后一天，他们被随机分为促红细胞生成素组（第0、4和6天皮下注射20000IU阿法依泊汀）加铁剂组（第1-6天肌肉注射100mg，G(1)）或仅用铁剂组（G(2)）。分别在第0、6、14、30、45和60天测量血细胞比容。
G(1)组有1例患者和G(2)组有2例患者失访。因此，分别对G(1)组的14例患者和G(2)组的13例患者进行了分析。研究开始时，两组患者的人口统计学特征、血清铁、铁蛋白、总铁结合力、网织红细胞和血细胞比容无显著差异。第6天两组的网织红细胞计数中位数有显著差异（G(1)组：4.0，3.0-6.4 vs G(2)组：3.5，2.1-4.4%，P=0.03），第14天的血细胞比容中位数也有显著差异[G(1)组：35.9，30.7-41.0 vs G(2)组：32.5，29.5-37.0%（中位数，范围），P=0.04]。
急性溃疡出血后给予促红细胞生成素能显著加速贫血的纠正。出血事件两周后血细胞比容的升高相当于输注一个单位的血液。
