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贫血是多发性骨髓瘤(multiple myeloma,MM)的常见症状,与预后不良相关。目前认为,MM相关性贫血是一种慢性病性贫血(anemia of chronic disease,ACD),由慢性炎症刺激所导致。铁调素(hepcidin)是一种机体铁代谢调节激素,它在炎症刺激下表达上调,使铁无法从细胞释放至血浆,造成血清铁降低,进而导致贫血发生。铁调素相关通路是MM相关性贫血发病机制中的中心环节,成为MM相关性贫血治疗的新靶点。促红细胞生成素类制剂(erythropoiesis-stimulating agent,ESA)能有效提高血红蛋白水平,是既往治疗MM相关性贫血的主要方法之一。近年ESA对肿瘤相关性贫血的治疗效果受到质疑,认为ESA可能促进肿瘤进展,并不能改善患者的总体预后。本文主要对MM相关性贫血的发病机制及治疗进行综述,着重阐述铁调素的作用机制,总结ESA的治疗效果,探讨铁调素通路的靶向治疗作用。
Anemia is a common symptom of multiple myeloma (MM), associated with poor prognosis. Currently, MM-related anemia is a type of anemia of chronic disease (ACD) caused by chronic inflammatory stimuli. Hepcidin, an iron metabolism regulator of the body, is up-regulated by inflammation and releases iron from cells into the plasma, causing a reduction in serum iron, leading to anemia. Hepcidin-related pathways are central to the pathogenesis of MM-related anemia and have become new targets for the treatment of MM-related anemia. Erythropoiesis-stimulating agent (ESA) can effectively increase hemoglobin level, which is one of the main methods for the treatment of MM-related anemia in the past. In recent years, the therapeutic effect of ESA on tumor-associated anemia has been questioned, suggesting that ESA may promote tumor progression and does not improve the patient’s overall prognosis. This review summarizes the pathogenesis and treatment of MM-related anemia, focuses on the mechanism of hepcidin, summarizes the therapeutic effect of ESA, and investigates the targeted therapeutic effect of hepcidin pathway.