Schrezenmeier H, Noé G, Raghavachar A, Rich I N, Heimpel H, Kubanek B
Department of Medicine III, University of Ulm, Germany.
Br J Haematol. 1994 Oct;88(2):286-94. doi: 10.1111/j.1365-2141.1994.tb05020.x.
Serum erythropoietin (EPO) and soluble transferrin receptor levels were serially measured in 74 patients with aplastic anaemia (AA). As control groups we investigated healthy controls (n = 24) and patients with iron-deficiency (n = 23) or haemolytic anaemia (n = 16). There was a significant negative correlation of log EPO on haematocrit both in AA patients and in the anaemic control group. However, for the same degree of anaemia, log EPO levels in AA were significantly higher than in iron-deficiency or haemolytic anaemia. EPO levels at diagnosis did not correlate with severity of aplastic anaemia, nor did they predict outcome after immunosuppression. During immunosuppressive treatment of AA with anti-thymocyte globulin and cyclosporine A, EPO levels were significantly lower compared with pre-treatment values without a corresponding change in haematocrit. This impaired EPO response to anaemia during immunosuppression might affect recovery of erythropoiesis. In AA patients, EPO levels declined with haemopoietic recovery. However, compared with normal controls, EPO levels in remission patients were still higher with respect to their haematocrit. Results of this study argue against the model of a simple feedback regulation of EPO via hypoxic anaemia. Our data support the hypothesis that cytokines and the erythropoietic progenitor pool are involved in the regulation of EPO production. The results illustrate that serial measurements of EPO along with therapeutic interventions are necessary to identify patients who might benefit from treatment with exogenous recombinant human EPO.
对74例再生障碍性贫血（AA）患者连续测定血清促红细胞生成素（EPO）和可溶性转铁蛋白受体水平。作为对照组，我们研究了健康对照者（n = 24）以及缺铁性贫血患者（n = 23）或溶血性贫血患者（n = 16）。AA患者和贫血对照组中，log EPO与血细胞比容均呈显著负相关。然而，对于相同程度的贫血，AA患者的log EPO水平显著高于缺铁性贫血或溶血性贫血患者。诊断时的EPO水平与再生障碍性贫血的严重程度无关，也不能预测免疫抑制治疗后的结果。在用抗胸腺细胞球蛋白和环孢素A对AA进行免疫抑制治疗期间，EPO水平与治疗前相比显著降低，而血细胞比容没有相应变化。免疫抑制期间EPO对贫血的反应受损可能会影响红细胞生成的恢复。在AA患者中，EPO水平随造血恢复而下降。然而，与正常对照组相比，缓解期患者的EPO水平相对于其血细胞比容仍较高。本研究结果反对通过低氧性贫血对EPO进行简单反馈调节的模型。我们的数据支持细胞因子和红细胞生成祖细胞池参与EPO产生调节的假说。结果表明，连续测定EPO以及进行治疗干预对于识别可能从外源性重组人EPO治疗中获益的患者是必要的。
