Khoshdel Alireza, Carney Shane, Gillies Alastair, Mourad Adnan, Jones Bernard, Nanra Ranjit, Trevillian Paul
Department of Nephrology, John Hunter Hospital, Faculty of Health, The University of Newcastle, NSW, Australia.
Diabetes Obes Metab. 2008 Jan;10(1):1-9. doi: 10.1111/j.1463-1326.2007.00711.x. Epub 2007 Jul 21.
Erythropoietin (EPO) is a haematopoietic cytokine, mainly generated in the renal cortex, and its secretion and action is impaired in chronic kidney disease (CKD). Early renal damage in diabetes mellitus (DM) is usually not detected because diabetes-induced nephron hypertrophy maintains glomerular filtration rate (GFR) and an elevated plasma creatinine concentration is a relatively late manifestation of diabetic nephropathy. However, anaemia occurs more frequently in subjects with DM when compared with those with non-DM renal disease. While reduced production and a blunted response to EPO occurs in DM with early renal damage, other factors including chronic inflammation, autonomic neuropathy and iron deficiency are also important. Although recombinant human erythropoietin (rhEPO) has been an effective therapeutic agent in CKD anaemia, it appears to be more effective in patients with DM, even in earlier stages. Nevertheless, patients with DM are also more likely to be iron deficient, a barrier to effective rhEPO therapy. The effect of treatment on the reliability of haemoglobin A(1c) as an index of glycaemic control must be remembered. It is proposed that anaemia and its causes must be important components of care in subjects with early diabetic renal damage.
促红细胞生成素（EPO）是一种造血细胞因子，主要在肾皮质产生，其分泌和作用在慢性肾脏病（CKD）中受损。糖尿病（DM）早期的肾脏损害通常难以检测到，因为糖尿病引起的肾单位肥大维持了肾小球滤过率（GFR），而血浆肌酐浓度升高是糖尿病肾病相对较晚出现的表现。然而，与非糖尿病肾病患者相比，DM患者贫血更为常见。虽然早期肾脏损害的DM患者EPO生成减少且对EPO反应迟钝，但其他因素如慢性炎症、自主神经病变和缺铁也很重要。尽管重组人促红细胞生成素（rhEPO）一直是治疗CKD贫血的有效药物，但在DM患者中似乎更有效，即使在疾病早期也是如此。然而，DM患者也更易缺铁，这是rhEPO有效治疗的障碍。必须牢记治疗对血红蛋白A1c作为血糖控制指标可靠性的影响。有人提出，贫血及其病因必定是早期糖尿病肾脏损害患者护理的重要组成部分。
