Brunet P, Berland Y, Merzouk T, Vanuxem D, Badier M, Klinkmann H, Crevat A
Service de Néphrologie, Hôpital Sainte Marguerite, Marseille, France.
Nephron. 1994;66(2):147-52. doi: 10.1159/000187792.
Anemia of chronic renal failure is associated with a reduced affinity of hemoglobin for oxygen (Hb-O2 affinity). It has been reported that the correction of renal anemia by recombinant human erythropoietin (rhuEPO) treatment could be associated paradoxically with a further decrease in Hb-O2 affinity. We investigated changes in the compensatory mechanisms of chronic renal anemia during 25 weeks of rhuEPO treatment, in 19 chronic hemodialyzed (HD) patients. There was no significant variation of mean standard P50 (P50std). Average 2,3-diphosphoglycerate (DPG) increased after 13 weeks and remained stable. The large interindividual variations prompted us to study delta P50std and delta Hb. We demonstrated a negative correlation between delta P50std and delta Hb. Thus, P50std increased in patients who did not immediately correct their anemia and decreased in patients whose Hb values rose. These data showed that the major factor influencing variations of Hb-O2 affinity in chronic HD patients treated by rhuEPO is the variation of Hb concentrations. In our study, it was demonstrated that the most important rise in P50std and 2,3-DPG occurred in patients who were late responders to rhuEPO.
慢性肾衰竭贫血与血红蛋白对氧的亲和力（Hb - O₂亲和力）降低有关。据报道，用重组人促红细胞生成素（rhuEPO）治疗纠正肾性贫血可能反常地伴随着Hb - O₂亲和力的进一步降低。我们调查了19例慢性血液透析（HD）患者在rhuEPO治疗25周期间慢性肾性贫血代偿机制的变化。平均标准P50（P50std）无显著变化。平均2,3 - 二磷酸甘油酸（DPG）在13周后升高并保持稳定。个体间的巨大差异促使我们研究ΔP50std和ΔHb。我们证明了ΔP50std与ΔHb之间呈负相关。因此，贫血未立即纠正的患者P50std升高，而Hb值上升的患者P50std降低。这些数据表明，rhuEPO治疗的慢性HD患者中影响Hb - O₂亲和力变化的主要因素是Hb浓度的变化。在我们的研究中，证明P50std和2,3 - DPG升高最为明显的是rhuEPO治疗的延迟反应者。
