Pavlidis George, Papageorgiou Sotirios G, Bazani Efthimia, Bouchla Anthi, Glezou Eirini, Gkontopoulos Konstantinos, Thomopoulos Thomas, Pappa Vasiliki, Vlahakos Demetrios V
2nd Department of Internal Medicine - Propaedeutic and Research Unit, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", Athens, Greece.
2nd Department of Internal Medicine - Propaedeutic and Research Unit, National and Kapodistrian University of Athens, Medical School, University General Hospital "Attikon", 1 Rimini St., Haidari, Athens, 12462, Greece.
Ther Adv Hematol. 2021 Jan 13;12:2040620720958299. doi: 10.1177/2040620720958299. eCollection 2021.
Renin-angiotensin system (RAS) blockade by angiotensin-converting enzyme inhibitors (ACEis) or angiotensin-receptor blockers (ARBs) has been related to anemia in various situations. We aimed to investigate whether discontinuation of RAS inhibitors improves erythropoiesis in patients with lower-risk myelodysplastic syndromes (LR-MDSs). Seventy-four patients with LR-MDS were divided into three groups matched for gender and age. Group A consisted of 20 hypertensive patients who discontinued RAS inhibitors and received alternative medications. Group B consisted of 26 patients who continued to receive ACEi/ARB and Group C included 28 patients (50% hypertensive) never exposed to ACEi/ARB. Half of the patients in each group were under treatment with recombinant human erythropoietin (rHuEPO). Data were collected at baseline and after 3, 6 and 12 months. Group A showed a significant increase in hemoglobin from 10.4 ± 1g/dL at baseline to 12.6 ± 1.2 g/dL after 12 months ( = 0.035) and in hematocrit (31.4 ± 3% 37.9 ± 4%, = 0.002). Incident anemia decreased from 100% at baseline to 60% at 12 months ( = 0.043) despite a concomitant dose reduction in rHuEPO by 18% ( = 0.035). No changes in hemoglobin and hematocrit were observed in both Group B and Group C. In the subset of patients not treated with rHuEPO, improvement of erythropoiesis was found only in Group A, as measured by changes in hemoglobin (11.5 ± 1 g/dL 12.4 ± 1.3 g/dL, = 0.041) and hematocrit (34.5 ± 3% 37.1 ± 4%, = 0.038) after 12 months. In contrast, Group B and Group C decreased hemoglobin and hematocrit after 12 months ( < 0.05). In conclusion, discontinuation of ACEi/ARB in LR-MDS patients is followed by a significant recovery of erythropoiesis after 12 months.
在各种情况下，使用血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）阻断肾素-血管紧张素系统（RAS）都与贫血有关。我们旨在研究停用RAS抑制剂是否能改善低危骨髓增生异常综合征（LR-MDS）患者的红细胞生成。74例LR-MDS患者按性别和年龄匹配分为三组。A组由20例停用RAS抑制剂并接受替代药物治疗的高血压患者组成。B组由26例继续接受ACEI/ARB治疗的患者组成，C组包括28例（50%为高血压患者）从未接触过ACEI/ARB的患者。每组一半的患者接受重组人促红细胞生成素（rHuEPO）治疗。在基线以及3、6和12个月后收集数据。A组患者的血红蛋白从基线时的10.4±1g/dL显著增加到12个月后的12.6±1.2g/dL（P=0.035），血细胞比容也显著增加（从31.4±3%增加到37.9±4%，P=0.002）。尽管rHuEPO剂量同时降低了18%（P=0.035），但新发贫血从基线时的100%降至12个月时的60%（P=0.043）。B组和C组的血红蛋白和血细胞比容均未观察到变化。在未接受rHuEPO治疗的患者亚组中，仅A组的红细胞生成有所改善，12个月后血红蛋白（从11.5±1g/dL增加到12.4±1.3g/dL，P=0.041）和血细胞比容（从34.5±3%增加到37.1±4%，P=0.038）均有变化。相比之下，B组和C组在12个月后血红蛋白和血细胞比容下降（P<0.05）。总之，LR-MDS患者停用ACEI/ARB后，12个月后红细胞生成显著恢复。
