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[同种异体肾移植前后的红细胞生成及血清促红细胞生成素浓度]

[Erythropoiesis and serum erythropoietin concentrations before and after kidney allotransplantation].

作者信息

Keusch G, Kurtz A, Fehr J, Eckardt K U, Frei D, Bauer C, Binswanger U

机构信息

Departement für Innere Medizin, Universitätsspital, Schweiz.

出版信息

Nephron. 1989;51 Suppl 1:29-33. doi: 10.1159/000185568.

Abstract

Hematological parameters and serum erythropoietin (EPO) levels were measured before and sequentially after grafting in 50 consecutive cadaver renal transplant recipients. EPO was estimated using a sensitive radioimmunoassay. Values for nonanemic controls were 15-25 mU/ml. Mean hematological values before transplantation were as follows: hemoglobin 9.7 +/- 2.4 g/dl; hematocrit 29 +/- 8%; corrected reticulocytes count 15 +/- 8% and EPO 29 +/- 23 (11-131) mU/ml. In the entire studied population, 35 patients had inadequate low EPO levels for their degree of anemia. In the whole population, there was a significant positive exponential correlation between EPO and hematocrit (r = 0.31; p less than 0.05). In the subset of patients with underlying cystic kidney disease and in hemodialysis patients treated with recombinant human EPO, hemoglobin, hematocrit and EPO levels were higher when compared to hemodialysis or CAPD patients with other kidney diseases. Following successful renal transplantation, EPO increased to 45 +/- 31 mU/ml at 1 month and then decreased to 25 +/- 18, 18 +/- 7 and 19 +/- 4 mU/ml at 3,6 and 9 months, respectively. Within the 1st month after transplantation there was a 4-fold increase in reticulocytes from 9 +/- 5 to 38 +/- 14%, followed by a slow decrease over the next several months to 23 +/- 11% at 9 months. In contrast, the hematocrit level rose more gradually from 28 +/- 7 to 44 +/- 6% at 9 months. In 25 of 36 patients with a functioning graft who were followed for more than 6 months, anemia was corrected and 11 patients remained slightly anemic with a mean hematocrit level of 36 +/- 4%.

摘要

对50例连续的尸体肾移植受者在移植前及移植后依次进行血液学参数和血清促红细胞生成素(EPO)水平的检测。采用灵敏的放射免疫分析法测定EPO。非贫血对照组的值为15 - 25 mU/ml。移植前的平均血液学值如下:血红蛋白9.7±2.4 g/dl;血细胞比容29±8%;校正网织红细胞计数15±8%,EPO 29±23(11 - 131)mU/ml。在整个研究人群中,35例患者的EPO水平与其贫血程度不相称地低。在整个人群中,EPO与血细胞比容之间存在显著的正指数相关性(r = 0.31;p < 0.05)。在患有潜在囊性肾病的患者亚组以及接受重组人EPO治疗的血液透析患者中,与患有其他肾病的血液透析或持续性非卧床腹膜透析(CAPD)患者相比,血红蛋白、血细胞比容和EPO水平更高。肾移植成功后,EPO在1个月时升至45±31 mU/ml,然后在3、6和9个月时分别降至25±18、18±7和19±4 mU/ml。移植后第1个月内,网织红细胞从9±5%增加至38±14%,增加了4倍,随后在接下来的几个月中缓慢下降,至9个月时降至23±11%。相比之下,血细胞比容水平从28±7%在9个月时更逐渐地升至44±6%。在36例移植肾功能良好且随访超过6个月的患者中,25例患者的贫血得到纠正,11例患者仍有轻度贫血,平均血细胞比容水平为36±4%。

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