Eschbach J W, Egrie J C, Downing M R, Browne J K, Adamson J W
N Engl J Med. 1987 Jan 8;316(2):73-8. doi: 10.1056/NEJM198701083160203.
We administered recombinant human erythropoietin to 25 anemic patients with end-stage renal disease who were undergoing hemodialysis. The recombinant human erythropoietin was given intravenously three times weekly after dialysis, and transfusion requirements, hematocrit, ferrokinetics, and reticulocyte responses were monitored. Over a range of doses between 15 and 500 units per kilogram of body weight, dose-dependent increases in effective erythropoiesis were noted. At 500 units per kilogram, changes in the hematocrit of as much as 10 percentage points were seen within three weeks, and increases in ferrokinetics of three to four times basal values, as measured by erythron transferrin uptake, were observed. Of 18 patients receiving effective doses of recombinant human erythropoietin, 12 who had required transfusions no longer needed them, and in 11 the hematocrit increased to 35 percent or more. Along with the rise in hematocrit, four patients had an increase in blood pressure, and a majority had increases in serum creatinine and potassium levels. No organ dysfunction or other toxic effects were observed, and no antibodies to the recombinant hormone were formed. These results demonstrate that recombinant human erythropoietin is effective, can eliminate the need for transfusions with their risks of immunologic sensitization, infection, and iron overload, and can restore the hematocrit to normal in many patients with the anemia of end-stage renal disease.
我们对25例正在接受血液透析的终末期肾病贫血患者给予重组人促红细胞生成素。重组人促红细胞生成素在透析后每周静脉注射3次，并监测输血需求、血细胞比容、铁动力学和网织红细胞反应。在每公斤体重15至500单位的剂量范围内，观察到有效红细胞生成呈剂量依赖性增加。在每公斤500单位时，3周内血细胞比容变化高达10个百分点，通过红细胞转铁蛋白摄取量测量，铁动力学增加至基础值的三到四倍。在18例接受有效剂量重组人促红细胞生成素的患者中，12例曾需要输血的患者不再需要输血，11例患者的血细胞比容升至35%或更高。随着血细胞比容升高，4例患者血压升高，大多数患者血清肌酐和钾水平升高。未观察到器官功能障碍或其他毒性作用，也未形成针对重组激素的抗体。这些结果表明，重组人促红细胞生成素是有效的，可消除输血需求及其免疫致敏、感染和铁过载风险，并可使许多终末期肾病贫血患者的血细胞比容恢复正常。
