Tarng D C, Huang T P, Doong T I
Department of Medicine, Veterans General Hospital-Taipei, and National Yang-Ming University School of Medicine, Taiwan.
Nephron. 1998;78(3):253-9. doi: 10.1159/000044931.
Despite a large body of evidence showing the beneficial effects of successful treatment of anemia with recombinant human erythropoietin (EPO) in patients with end-stage renal disease, controversy remains as to whether EPO treatment of anemia can improve the nutritional status in patients on maintenance hemodialysis. This prompted us to conduct a prospective study in 41 hemodialysis patients with basal hemoglobin less than 9 g/dl. The dose of EPO was increased for 12 weeks to achieve the target hemoglobin concentration of 10 g/dl and then titrated in the following 12 weeks to maintain the target value. Nutritional status was assessed at baseline and after 6 months of follow-up, using the global protein-calorie malnutrition (PCM) index proposed by Bilbrey and Cohen. A low global PCM score indicates better nutrition. The results showed that hemoglobin values significantly increased from 8.7 +/- 0.8 g/dl at baseline to 10.7 +/- 0.5 g/dl in the 6th month (p < 0.001). No significant changes were observed in the normalized protein catabolic rate and Kt/V during the study period. Global PCM scores improved from 30.0 +/- 7.5 to 23.6 +/- 3.1 (p < 0.001) and paralleled the correction of anemia by EPO treatment. The data were consistent with a major improvement in the nutritional markers of relative body weight, triceps skinfold, midarm circumference, midarm muscle circumference, serum albumin, serum transferrin and total lymphocyte count in the 6th month as compared to baseline. The percentages of mild and moderate-severe PCM at baseline were 32 and 58%, respectively. These percentages were significantly reduced during the 6th month to 20 and 30%, respectively (p = 0.0004). In summary, correction of renal anemia with EPO improves the nutritional status in hemodialysis patients. A postulated mechanism is that EPO may exhibit anabolic effects, with a better utilization of ingested protein.
尽管有大量证据表明，重组人促红细胞生成素（EPO）成功治疗终末期肾病患者的贫血具有有益效果，但对于EPO治疗贫血能否改善维持性血液透析患者的营养状况仍存在争议。这促使我们对41例基础血红蛋白低于9 g/dl的血液透析患者进行了一项前瞻性研究。EPO剂量增加12周以达到目标血红蛋白浓度10 g/dl，然后在接下来的12周进行滴定以维持目标值。在基线和随访6个月后，使用Bilbrey和Cohen提出的整体蛋白质 - 热量营养不良（PCM）指数评估营养状况。低整体PCM评分表明营养状况更好。结果显示，血红蛋白值从基线时的8.7±0.8 g/dl显著增加至第6个月时的10.7±0.5 g/dl（p < 0.001）。在研究期间，标准化蛋白质分解代谢率和Kt/V未观察到显著变化。整体PCM评分从30.0±7.5改善至23.6±3.1（p < 0.001），并与EPO治疗纠正贫血情况平行。与基线相比，第6个月时相对体重、三头肌皮褶厚度、上臂围、上臂肌肉围、血清白蛋白、血清转铁蛋白和总淋巴细胞计数等营养指标有显著改善，数据与之相符。基线时轻度和中度 - 重度PCM的百分比分别为32%和58%。在第6个月时，这些百分比分别显著降至20%和30%（p = 0.0004）。总之，用EPO纠正肾性贫血可改善血液透析患者的营养状况。一种推测的机制是，EPO可能具有合成代谢作用，能更好地利用摄入的蛋白质。
