Drüeke T B
INSERM, Unité 90, Hôpital Necker, Paris, France.
Am J Nephrol. 1990;10 Suppl 2:34-9. doi: 10.1159/000168215.
The administration of recombinant human erythropoietin (rHuEPO) to anemic hemodialysis patients is usually followed by a rapid increase in hemoglobin. Initial 'nonresponders' may either respond to higher doses of rHuEPO or rarely may remain totally unresponsive. Schematically, one can distinguish between a state of relative and absolute resistance to the action of the hormone. The most common causes of resistance are iron deficiency, aluminium overload, episodes of infection or other inflammatory processes, probably severe hyperparathyroidism, acute or chronic hemolytic conditions, acute or chronic blood loss, folate deficiency, and hemoglobinopathies in exceptional instances. Antibody formation against rHuEPO or marrow fibrosis secondary to rHuEPO treatment can be discarded as potential causes of resistance.
给贫血的血液透析患者使用重组人促红细胞生成素（rHuEPO）后，血红蛋白通常会迅速升高。最初的“无反应者”可能对更高剂量的rHuEPO有反应，或者极少数情况下可能完全无反应。从理论上讲，可以区分对该激素作用的相对抵抗状态和绝对抵抗状态。抵抗的最常见原因是缺铁、铝过载、感染或其他炎症过程、可能是严重的甲状旁腺功能亢进、急性或慢性溶血情况、急性或慢性失血、叶酸缺乏以及在特殊情况下的血红蛋白病。针对rHuEPO的抗体形成或rHuEPO治疗继发的骨髓纤维化可被排除为抵抗的潜在原因。
