Nissenson A R, Nimer S D, Wolcott D L
Department of Medicine, UCLA School of Medicine.
Ann Intern Med. 1991 Mar 1;114(5):402-16. doi: 10.7326/0003-4819-114-5-402.
Anemia (hematocrit less than 25%) predictably accompanies chronic renal failure and is present in over 90% of patients on chronic dialysis. Relative erythropoietin deficiency is the proximate cause. Recombinant human erythropoietin recently became available for research and clinical use. Erythropoietin production is regulated by a single copy gene located on chromosome 7; its expression has been shown in the kidney, liver, and macrophages. It is glycosylated protein of 166 amino acids with a molecular weight of 34,000 D. When given to patients with the anemia of renal failure, erythropoietin causes a dose-dependent rise in hematocrit to the normal range within 8 to 14 weeks. Complications of this response are minimal except for a significant incidence of hypertension. When the anemia is corrected, the patient's quality of life, cognitive function, and brain electrophysiology improve dramatically. Recombinant human erythropoietin represents a major breakthrough in the treatment of patients with chronic renal failure. Current reimbursement constraints limit its full application.
贫血（血细胞比容低于25%）可预见地伴随慢性肾衰竭出现，且超过90%的慢性透析患者存在贫血。促红细胞生成素相对缺乏是其直接原因。重组人促红细胞生成素最近已可用于研究和临床应用。促红细胞生成素的产生由位于7号染色体上的单拷贝基因调控；其表达已在肾脏、肝脏和巨噬细胞中得到证实。它是一种由166个氨基酸组成的糖蛋白，分子量为34,000道尔顿。给肾衰竭贫血患者使用促红细胞生成素后，血细胞比容会在8至14周内呈剂量依赖性升高至正常范围。除高血压发生率较高外，这种反应的并发症极少。贫血得到纠正后，患者的生活质量、认知功能和脑电生理学都会显著改善。重组人促红细胞生成素代表了慢性肾衰竭患者治疗方面的一项重大突破。目前的报销限制阻碍了其全面应用。
