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目的 研究促红细胞生成素 (EPO)在类风湿性关节炎 (RA)贫血发生机制中的作用 ;探讨重组人EPO(rhuEPO)在RA贫血治疗中的适应证。方法 采用美国Amgen公司提供的试剂盒测定了 40例RA贫血患者血清EPO(s EPO)的水平 ,分析其与血红蛋白水平的相关性。结果 RA贫血患者s EPO水平 5 2 .0 (11.2～2 16 .0 )U/L明显高于正常对照 4.8(3.3～ 46 .9)U/L及RA非贫血患者 7.2 (0 .6～ 2 0 .7)U/L ,但低于IDA患者 145 .6 (2 .6～ 36 6 .0 )U/L(P <0 .0 0 1) ;RA贫血伴缺铁组、RA贫血不伴缺铁组和IDA组 3者血红蛋白 (Hb)与s EPO呈对数负相关 (P <0 .0 1) ,3条回归线的相关性、斜率差异无统计意义 (P >0 .0 5 ) ,但其中RA贫血伴缺铁组截距低于IDA组 (P <0 .0 5 ) ,高于不伴缺铁组 (P <0 .0 5 ) ;IDA患者O/P比值置信区间为 0 .82～ 1.19。结论 RA贫血存在s EPO相对缺乏 ,s EPO对贫血反应迟钝 ;RA贫血患者s EPO水平个体差异大 ,建议根据O/P值的大小评估rhuEPO的可能疗效 ;RA贫血伴缺铁患者于治疗时应首先选用铁剂 ,而非rhuEPO。
Objective To investigate the role of erythropoietin (EPO) in the pathogenesis of rheumatoid arthritis (RA) anemia and to explore the indications of recombinant human EPO (rhuEPO) in the treatment of RA anemia. Methods Serum levels of EPO (s EPO) were measured in 40 patients with RA anemia using the kit provided by Amgen Company in USA. The correlation between hemoglobin and hemoglobin levels was analyzed. Results The level of s EPO of RA patients was significantly higher than that of controls (4.8 ± 3.3) 0 .7) U / L but lower than 145.6 (2.6-666.0) U / L (P <0.01) in IDA patients; RA anemia with iron deficiency anemia without RA There was a logarithmic negative correlation between hemoglobin (Hb) and s EPO in iron deficiency group and IDA group (P <0.01), but there was no significant difference in slope between the three regression lines (P> 0.05) However, the intercept of RA anemia with iron deficiency group was lower than that of IDA group (P <0.05), and was higher than that of non-iron deficiency group (P <0.05). The O / P ratio of IDA patients was 0. 82 ~ 1.19. Conclusions There is a relative lack of s EPO in RA anemia and s EPO is unresponsive to anemia. Individual EPO levels in patients with RA anemia are highly individualized. It is recommended to evaluate the possible effect of rhuEPO according to the O / P value. Patients with RA anemia and iron deficiency should be treated First iron, rather than rhuEPO.