Gleissner Christian A, Klingenberg Roland, Staritz Peter, Koch Achim, Ehlermann Philipp, Wiggenhauser Alfred, Dengler Thomas J
Department of Cardiology, Angiology and Pneumonology, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
Int J Cardiol. 2006 Oct 10;112(3):341-7. doi: 10.1016/j.ijcard.2005.10.007. Epub 2005 Nov 23.
Anemia after heart transplantation is common; however, there are scant data on etiology and treatment. This study evaluates type of anemia and the effects of erythropoietin therapy.
In 37 anemic heart transplant recipients (31 male/59.1+/-10.3 years/hemoglobin <12.0 g/dl), complete anemia work-up was performed including erythropoietin determination. For three months, 12 anemic patients with renal failure (9 male/64.1+/-13.6 years) were treated with 1-3x4000 IU of epoietin beta/week; treatment endpoints were hemoglobin levels and quality of life as determined by questionnaire.
In 31 patients no other cause of anemia than renal insufficiency (mean creatinine 1.9+/-0.9 mg/dl, mean calculated GFR 50.8+/-21.5 ml/min, no hemodialysis) was found; in 93.5% of these patients with renal insufficiency, measured erythropoietin levels were markedly lower than predicted [Beguin Y, Clemons GK, Pootrakul P, Fillet G. Quantitative assessment of erythropoiesis and functional classification of anemia based on measurements of serum transferrin receptor and erythropoietin. Blood 1993; 81(4):1067-1076.]. There was an inverse correlation of hemoglobin levels with serum creatinine/creatinine clearance and a strong trend for inverse correlation of erythropoietin levels. All 12 patients treated with erythropoietin showed a significant increase in hemoglobin levels after three months returning to pre-treatment values within 3 months of cessation of therapy (before study 10.8+/-1.1 g/dl, end of study 14.1+/-1.7 g/dl, three months after end of study 11.6+/-2.1 g/dl; p<0.005). Quality of life was significantly improved in eight patients (75%).
Anemia after heart transplantation is associated with moderate renal failure and low erythropoietin levels in most patients. Erythropoietin therapy resulted in increased hemoglobin levels in all and improved quality of life in 75% of patients. Erythropoietin may be a superior marker of functional renal impairment after heart transplantation; its therapeutic substitution allows effective anemia management and improves quality of life.
心脏移植后贫血很常见；然而，关于其病因和治疗的数据却很少。本研究评估贫血类型及促红细胞生成素治疗的效果。
对37例贫血的心脏移植受者（31例男性，年龄59.1±10.3岁，血红蛋白<12.0 g/dl）进行了全面的贫血检查，包括促红细胞生成素测定。12例合并肾衰竭的贫血患者（9例男性，年龄64.1±13.6岁）接受了为期3个月的治疗，每周给予1 - 3次，每次4000 IU的β-促红细胞生成素；治疗终点为血红蛋白水平及通过问卷调查确定的生活质量。
31例患者除肾功能不全（平均肌酐1.9±0.9 mg/dl，平均计算肾小球滤过率50.8±21.5 ml/min，未进行血液透析）外未发现其他贫血原因；在这些肾功能不全的患者中，93.5%的患者促红细胞生成素实测水平明显低于预测值[贝甘Y，克莱蒙斯GK，普特拉库尔P，菲利特G。基于血清转铁蛋白受体和促红细胞生成素测定的红细胞生成定量评估及贫血功能分类。《血液》1993年；81(4):1067 - 1076。]。血红蛋白水平与血清肌酐/肌酐清除率呈负相关，促红细胞生成素水平也有明显的负相关趋势。所有12例接受促红细胞生成素治疗的患者在3个月后血红蛋白水平均显著升高，在治疗停止后3个月内恢复到治疗前水平（研究前10.8±1.1 g/dl，研究结束时14.1±1.7 g/dl，研究结束后3个月11.6±2.1 g/dl；p<0.005）。8例患者（75%）的生活质量得到显著改善。
心脏移植后贫血在大多数患者中与中度肾衰竭及促红细胞生成素水平低有关。促红细胞生成素治疗使所有患者的血红蛋白水平升高，75%的患者生活质量得到改善。促红细胞生成素可能是心脏移植后功能性肾功能损害的一个更好指标；其治疗性替代可有效管理贫血并改善生活质量。
