de Paoli Vitali E, Ricci G, Perini L, Malacarne F, Vedovato M, Guerra G, Dapporto M, Gilli P
Divisione di Nefrologia, Arcispedale S. Anna, Ferrara, Italia.
Nephron. 1996;72(4):552-6. doi: 10.1159/000188938.
Both the plasma determinations of erythropoietic (EPO) and transferrin receptor (TfR) would provide a good characterization of anemia especially when mixed erythron disorders underlie, such as in renal failure. Immunologic assays of EPO and TfR, as well as standard hematologic determinations (hematocrit, reticulocyte count, serum iron, transferrin, ferritin) were performed in patients with chronic renal failure (CRF), in regular dialysis treatment (RDT) and in transplanted (TX) patients. In nonanemic TX patients both EPO and TfR ranged normally, whereas in anemic TX ones (Hct < 40%) both values were increased suggesting the physiologic response both of the kidney and of the erythron to decreased red cell mass. In transitory posttransplant erythrocytosis the increased values of TfR, with normal EPO values, would hypothesize a defective feedback to EPO release. Both EPO and TfR values were found increased in TX patients with adult polycystic kidney disease with persistent erythrocytosis (Hct > 50%), thus confirming previous observations. In CRF and RDT patients, all anemic, both EPO and TfR were normal, even though significantly low with respect to the degree of anemia. In RDT seriously anemic patients, the administration of recombinant human EPO induced different patterns of bone marrow response. We conclude that the determination of TfR would provide further information on renal anemia since the receptor increase mostly preceded the rise of Hct, evidencing those patients who will not have an effective bone marrow response to the therapy.
促红细胞生成素（EPO）和转铁蛋白受体（TfR）的血浆测定都能很好地表征贫血，尤其是在存在混合性红细胞疾病的情况下，如肾衰竭。我们对慢性肾衰竭（CRF）患者、接受定期透析治疗（RDT）的患者以及接受移植（TX）的患者进行了EPO和TfR的免疫测定，以及标准血液学检测（血细胞比容、网织红细胞计数、血清铁、转铁蛋白、铁蛋白）。在非贫血的TX患者中，EPO和TfR水平正常，而在贫血的TX患者中（血细胞比容<40%），这两个值均升高，表明肾脏和红细胞对红细胞量减少的生理反应。在移植后短暂性红细胞增多症中，TfR值升高而EPO值正常，这可能意味着对EPO释放的反馈存在缺陷。在患有成人多囊肾疾病且持续红细胞增多症（血细胞比容>50%）的TX患者中，EPO和TfR值均升高，从而证实了先前的观察结果。在CRF和RDT患者中，所有患者均贫血，EPO和TfR均正常，尽管相对于贫血程度明显偏低。在RDT严重贫血患者中，给予重组人EPO会诱导不同的骨髓反应模式。我们得出结论，TfR的测定可为肾性贫血提供更多信息，因为受体增加大多先于血细胞比容升高，可识别出那些对治疗不会产生有效骨髓反应的患者。
