Beckingham I J, Woodrow G, Hinwood M, Rigg K M, Morgan A G, Burden R P, Broughton-Pipkin F
Department of Surgery, University Hospital, Nottingham.
Nephrol Dial Transplant. 1995 Dec;10(12):2316-20. doi: 10.1093/ndt/10.12.2316.
Erythrocytosis is a common complication of renal transplantation with an incidence of up to 17%. It is associated with an increased risk of complications due to thromboembolic events and has traditionally been treated by intermittent venesection. More recently, angiotensin-converting enzyme inhibitors have been shown to cause a fall in haematocrit in a number of groups of subjects and some uncontrolled studies have shown these drugs to be of possible therapeutic benefit in post renal transplant erythrocytosis.
We performed a randomized double-blind placebo-controlled study in 25 patients with post-transplant erythrocytosis. Subjects received either 2.5 mg of enalapril daily or a placebo for 4 months and all patients completed the study period without any serious adverse effects.
Haematocrit fell from 52.7 (+/- SEM 0.7) to 47.1 (+/- 1.8) at 1 month and 46.1 (+/- 1.2) after 4 months in patients receiving enalapril, with no change in the placebo group (P = 0.004). We did not demonstrate any change in serum erythropoietin in either group.
Angiotensin-converting enzyme inhibitors are a safe and effective form of treatment for erythrocytosis developing after renal transplantation. The mechanism of action, however, is not mediated by changes in erythropoietin production and remains uncertain.
红细胞增多症是肾移植常见的并发症，发病率高达17%。它与血栓栓塞事件导致的并发症风险增加相关，传统上通过间歇性放血治疗。最近，血管紧张素转换酶抑制剂已被证明能使一些受试者群体的血细胞比容下降，一些非对照研究表明这些药物对肾移植后红细胞增多症可能具有治疗益处。
我们对25例移植后红细胞增多症患者进行了一项随机双盲安慰剂对照研究。受试者每日接受2.5毫克依那普利或安慰剂治疗4个月，所有患者均完成研究期，未出现任何严重不良反应。
接受依那普利治疗的患者，血细胞比容在1个月时从52.7（±标准误0.7）降至47.1（±1.8），4个月后降至46.1（±1.2），而安慰剂组无变化（P = 0.004）。两组的血清促红细胞生成素均未显示有任何变化。
血管紧张素转换酶抑制剂是治疗肾移植后发生的红细胞增多症的一种安全有效的方法。然而，其作用机制并非由促红细胞生成素产生的变化介导，仍不确定。
