Ferrucci Luigi, Balducci Lodovico
Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, 3001 S. Harbor Street, Baltimore, MD 21225, USA.
Semin Hematol. 2008 Oct;45(4):242-9. doi: 10.1053/j.seminhematol.2008.06.001.
Aging is associated with increased incidence and prevalence of anemia, leading to a number of adverse health outcomes. These include death, functional dependence, increased risk of therapeutic complications, falls, and dementia. In approximately 30% of cases, anemia in older individuals is due to either relative or absolute erythropoietin (EPO) deficiency. Absolute EPO deficiency may be primary or secondary to declining renal function. Relative EPO deficiency is due to an age-related pro-inflammatory status that reduces the sensitivity of erythropoietic precursors to EPO. Despite this condition of EPO deficiency, the management of anemia of aging with erythropoiesis-stimulating agents (ESAs) is controversial, unless the anemia is due to renal insufficiency. The main concern related to this treatment arises from eight studies of ESAs in cancer, suggesting that ESAs may reduce patient survival in addition to increasing the risk of deep vein thrombosis. The results of these studies contrast with a host of other trials showing the safety of ESAs. The discrepancy may be explained in part by the fact that, in the trials suggesting a detrimental effect of ESAs, the goal was to obtain hemoglobin (Hb) levels higher than 12 g/dL. Because of this concern, correction of anemia in elderly individuals with relative EPO insufficiency should not be attempted outside clinical trials.
衰老与贫血的发病率和患病率增加相关，会导致一系列不良健康后果。这些后果包括死亡、功能依赖、治疗并发症风险增加、跌倒和痴呆。在大约30%的病例中，老年人贫血是由于相对或绝对的促红细胞生成素（EPO）缺乏。绝对EPO缺乏可能是原发性的，也可能继发于肾功能下降。相对EPO缺乏是由于与年龄相关的促炎状态，降低了红细胞生成前体细胞对EPO的敏感性。尽管存在EPO缺乏的情况，但除非贫血是由肾功能不全引起的，否则使用促红细胞生成剂（ESAs）治疗老年贫血仍存在争议。与这种治疗相关的主要担忧源于八项关于ESAs在癌症中的研究，表明ESAs除了增加深静脉血栓形成的风险外，还可能降低患者生存率。这些研究结果与许多其他显示ESAs安全性的试验形成对比。这种差异部分可以解释为，在表明ESAs有有害作用的试验中，目标是使血红蛋白（Hb）水平高于12 g/dL。由于这种担忧，在临床试验之外不应尝试纠正相对EPO不足的老年个体的贫血。
