Vreugdenhil G, Swaak A J
Zuiderziekenhuis, Department of Internal Medicine, Rotterdam, The Netherlands.
Rheumatol Int. 1990;9(6):243-57. doi: 10.1007/BF00541320.
The pathogenesis, diagnosis and treatment of the anaemia of chronic disorders (ACD) in rheumatoid arthritis (RA) were reviewed. Causes of anaemia other than ACD frequently present in RA. Decreased iron absorption was shown to be the result of active RA rather than a cause of ACD or iron deficiency. It has been hypothesized that bone marrow iron availability decreases due to decreased iron release by the mononuclear phagocyte system or that the anaemia in ACD is due to ineffective erythropoiesis; these remain controversial theories. Studies considering a decreased erythropoietin responsiveness have not produced consistent results. Erythroid colony growth is suppressed in vitro by interleukins and tumour necrosis factor but their role in vivo in ACD is unknown. The diagnosis of ACD is made by exclusion. Iron deficiency is detected by transferrin, ferritin, and cellular indices after adaptation of their normal values. Treatment of the anaemia consists merely of antirheumatic treatment. Iron administration is counterproductive since iron chelators or exogenous erythropoietin administration might increase erythropoiesis.
本文综述了类风湿关节炎（RA）中慢性病性贫血（ACD）的发病机制、诊断和治疗。RA中除ACD外还常出现其他贫血原因。铁吸收减少被证明是活动性RA的结果，而非ACD或缺铁的原因。有假说认为，单核吞噬细胞系统铁释放减少导致骨髓铁供应减少，或者ACD中的贫血是由于无效造血；这些仍是有争议的理论。考虑促红细胞生成素反应性降低的研究未得出一致结果。白细胞介素和肿瘤坏死因子在体外可抑制红系集落生长，但其在ACD体内的作用尚不清楚。ACD的诊断通过排除法做出。缺铁通过转铁蛋白、铁蛋白以及校正其正常值后的细胞指标来检测。贫血的治疗仅包括抗风湿治疗。补充铁剂会适得其反，因为铁螯合剂或外源性促红细胞生成素的使用可能会增加造血。
