肺移植受者的贫血与促红细胞生成素水平

Anemia and erythropoietin levels in lung transplant recipients.

作者信息

End A, Stift A, Wieselthaler G, Griesmacher A, Schlechta B, Koppensteiner R, Schreiner W, Geissler K, Stockenhuber F, Klepetko W

机构信息

Department of Surgery, University of Vienna, Austria.

出版信息

Transplantation. 1995 Dec 15;60(11):1245-51.

PMID:8525518

Abstract

An evaluation of 26 surviving outpatient lung transplant recipients at one center showed that 65% (17/26) had significant anemia (hemoglobin < 11 g/L for women, < 14 g/dl for men) at a median follow-up of 13.5 months after transplantation (range, 1-41 months). There were 14 men and 12 women with a mean age of 45.1 years (range, 23.1-66.7 years). Fifteen had a double allograft and 11 had a single allograft. Anemia was normochromic and normocytic/macrocytic with a tendency to anisocytosis, with normal reticulocyte counts. Iron deficiency (transferrin saturation < 20%) was found in 35% (6/17) of anemic patients, and two of them also had ferritin levels < 15 micrograms/L. In addition, vitamin B12 was decreased in 1 patient. Folate levels were all normal. Erythropoietin levels were significantly decreased in anemic lung transplant recipients as compared with nontransplanted iron-deficient anemic patients (median, 1 mU/ml, range 1-41 mU/ml, vs. 53 mU/ml, 15-88 mU/ml; P < 0.05). In nonanemic lung transplant recipients, erythropoietin levels were decreased too, as compared with normal controls (median, 2 mU/ml, range 1-21 mU/ml, vs. 5 mU/ml, 3-32 mU/ml; P < 0.05). Investigation of peripheral stem cells in 9 patients showed normal stimulation of erythroids (burst-forming unit, erythroid; median, 573 cells/ml; range, 128-1898 cells/ml) independent of erythropoietin concentrations. Analysis of putative prognostic factors, such as age, surgical procedure (double vs. single lung allograft), indication for transplantation, time after transplantation, infection status, presence of bronchiolitis obliterans, immunosuppression (+/- azathioprine), serum creatinine, creatinine clearance, hypertension, and arterial partial pressure of oxygen, did not demonstrate any difference in erythropoietin concentrations. Only the sex variable revealed a trend to higher levels in women than in men (median, 4 mU/ml, range 1-41 mU/ml, vs. 1 mU/ml, 1-16 mU/ml; P > 0.05). The causes for low erythropoietin levels are not quite understood yet; however, they offer a rationale for the treatment of chronic anemia with recombinant human erythropoietin.

摘要

对某一中心26名存活的门诊肺移植受者进行的评估显示，在移植后中位随访13.5个月（范围1 - 41个月）时，65%（17/26）的患者出现显著贫血（女性血红蛋白<11 g/L，男性<14 g/dl）。其中有14名男性和12名女性，平均年龄45.1岁（范围23.1 - 66.7岁）。15人接受了双肺移植，11人接受了单肺移植。贫血为正色素性、正细胞/大细胞性，有红细胞大小不均的倾向，网织红细胞计数正常。35%（6/17）的贫血患者存在缺铁（转铁蛋白饱和度<20%），其中2人铁蛋白水平也<15微克/L。此外，1例患者维生素B12水平降低。叶酸水平均正常。与未移植的缺铁性贫血患者相比，贫血的肺移植受者促红细胞生成素水平显著降低（中位值，1 mU/ml，范围1 - 41 mU/ml，对比53 mU/ml，15 - 88 mU/ml；P<0.05）。与正常对照组相比，非贫血的肺移植受者促红细胞生成素水平也降低（中位值，2 mU/ml，范围1 - 21 mU/ml，对比5 mU/ml，3 - 32 mU/ml；P<0.05）。对9例患者外周干细胞的研究显示，无论促红细胞生成素浓度如何，红系细胞（红细胞爆式集落形成单位）均受到正常刺激（中位值，573个细胞/ml；范围，128 - 1898个细胞/ml）。对可能的预后因素进行分析，如年龄、手术方式（双肺移植与单肺移植）、移植指征、移植后时间、感染状态、闭塞性细支气管炎的存在、免疫抑制（使用/不使用硫唑嘌呤）、血清肌酐、肌酐清除率、高血压以及动脉血氧分压，均未显示促红细胞生成素浓度存在差异。仅性别变量显示女性促红细胞生成素水平有高于男性的趋势（中位值分别为4 mU/ml，范围1 - 41 mU/ml，对比1 mU/ml，1 - 16 mU/ml；P>0.05）。促红细胞生成素水平降低的原因尚未完全明确；然而，这为使用重组人促红细胞生成素治疗慢性贫血提供了理论依据。