Tacke F, Schöffski P, Luedde T, Meier P N, Ganser A, Manns M P, Trautwein C
Dept. of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Scand J Gastroenterol. 2004 Mar;39(3):259-66. doi: 10.1080/00365520310008340.
Dysregulated erythropoietin (EPO) plasma levels may play a role in the pathophysiology of chronic liver disease (CLD) because chronic anaemia is frequently observed in patients with liver cirrhosis. We aimed to identify the factors contributing to EPO regulation in patients with CLD.
Plasma EPO concentrations were correlated with clinical and laboratory parameters in 111 CLD patients and 220 healthy controls.
Anaemia, though generally mild, was common in CLD patients, and thrombocytopenia and previous bleeding episodes were observed in two-thirds of the patients. Plasma EPO levels were significantly elevated in CLD patients (P < 0.001). EPO increased according to Child's stages of cirrhosis, independently of the aetiology of CLD. EPO correlated with haemoglobin (r= -0.498, P < 0.001). Additionally, EPO independently correlated with markers of liver dysfunction, e.g. prothrombin time, albumin concentration or cholinesterase activity, and platelet count. EPO was also significantly elevated in patients with a current bleeding tendency and with prior gastrointestinal haemorrhages. EPO levels were increased in patients with impaired pulmonary function, e.g. decreased diffusion capacity, vital capacity or hyperventilation. Interestingly, plasma interleukin-6 (IL-6) concentrations positively correlated with EPO (r=0.277, P = 0.003), suggesting a possible mechanism of EPO upregulation in patients with CLD through IL-6 dependent pathways, e.g. binding of STAT transcription factors in the putative EPO promoter region.
EPO is upregulated in patients with chronic liver diseases in response to anaemia, bleeding complications, impaired pulmonary function, thrombocytopenia and liver dysfunction. IL-6 dependent pathways could be involved in mediating elevated EPO levels in CLD patients.
促红细胞生成素（EPO）血浆水平失调可能在慢性肝病（CLD）的病理生理学中起作用，因为肝硬化患者常出现慢性贫血。我们旨在确定导致CLD患者EPO调节的因素。
对111例CLD患者和220例健康对照者的血浆EPO浓度与临床和实验室参数进行相关性分析。
贫血在CLD患者中很常见，虽然一般较轻，并且三分之二的患者出现血小板减少和既往出血史。CLD患者的血浆EPO水平显著升高（P < 0.001）。EPO根据肝硬化的Child分期升高，与CLD的病因无关。EPO与血红蛋白相关（r = -0.498，P < 0.001）。此外，EPO与肝功能障碍指标独立相关，例如凝血酶原时间、白蛋白浓度或胆碱酯酶活性以及血小板计数。目前有出血倾向和既往有胃肠道出血的患者中EPO也显著升高。肺功能受损患者（例如弥散能力降低、肺活量降低或通气过度）的EPO水平升高。有趣的是，血浆白细胞介素-6（IL-6）浓度与EPO呈正相关（r = 0.277，P = 0.003），提示CLD患者中EPO上调可能通过IL-6依赖途径，例如STAT转录因子在假定的EPO启动子区域的结合。
慢性肝病患者的EPO因贫血、出血并发症、肺功能受损、血小板减少和肝功能障碍而上调。IL-6依赖途径可能参与介导CLD患者EPO水平升高。
