Mohammadpour Amir-Hooshang, Nazemian Fatemeh, Khaiat Mohammad Hassanzade, Tafaghodi Mohsen, Salari Pooneh, Charkazi Somaieh, Naghibi Masih, Shamsara Jamal
Nephrology Ward, Department of Internal Medicine, Imam-Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Saudi J Kidney Dis Transpl. 2014 Jan;25(1):73-8. doi: 10.4103/1319-2442.124492.
Use of recombinant human erythropoietin (rh-Epo) improves hemoglobin (Hgb) in 90-95% of the cases of anemia of chronic kidney disease (CKD). However, it is known that pro-inflammatory cytokines such as interferon-gamma (IFN-γ), tumor necrosis factor-alfa (TNF-α) and interleukin-1 (IL-1) suppress erythropoiesis, resulting in inadequate response to rh-Epo. Pentoxifylline has been shown to have modulatory effects on the immune system. This prospective study to evaluate the effect of pentoxyphylline on erythropoeisis was performed on 15 (eight males, seven females) clinically stable patients who had been on hemodialysis for at least six months with anemia (Hgb of <10.7 g/dL) unresponsive to rh-Epo despite high doses. They were treated with 400 mg pentoxifylline tablets once daily for 12 weeks. Hgb increased after one and two months of drug administration, but significant changes were observed in eight (53%) patients after three months (P <0.05). Our study illustrates a probable new use for an old medicine. Three months treatment with pentoxifylline was seen to increase Hgb significantly in rh-Epo-resistant patients. More prospective studies with a larger sample size are needed to determine the inhibitory role of cytokines on hematopoiesis and exploring new drugs or new drug indications to overcome anemia in advanced renal failure.
使用重组人促红细胞生成素（rh-Epo）可使90%至95%的慢性肾脏病（CKD）贫血患者的血红蛋白（Hgb）水平得到改善。然而，已知诸如干扰素-γ（IFN-γ）、肿瘤坏死因子-α（TNF-α）和白细胞介素-1（IL-1）等促炎细胞因子会抑制红细胞生成，导致对rh-Epo的反应不足。已证明己酮可可碱对免疫系统具有调节作用。本前瞻性研究对15名（8名男性，7名女性）临床稳定的患者进行，这些患者接受血液透析至少六个月，患有贫血（Hgb<10.7 g/dL），尽管使用高剂量rh-Epo但仍无反应。他们每天服用一次400毫克己酮可可碱片，持续12周。给药1个月和2个月后Hgb升高，但3个月后8名（53%）患者出现显著变化（P<0.05）。我们的研究揭示了一种旧药可能的新用途。己酮可可碱治疗3个月可使rh-Epo抵抗患者的Hgb显著升高。需要进行更多样本量更大的前瞻性研究，以确定细胞因子对造血的抑制作用，并探索克服晚期肾衰竭贫血的新药或新的药物适应症。
