頁籤選單縮合
題名 | Analysis of Initial Factors of Differences in Dose Requirements of Human Recombinant Erythropoietin Treatment in Stable Hemodialysis Patients=人工合成紅血球生成素治療效果的影響因素分析 |
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作者 | 邱文淵; 連榮達; 林圭彥; 楊郁; |
期刊 | 中華民國腎臟醫學會雜誌 |
出版日期 | 19941200 |
卷期 | 8:4 1994.12[民83.12] |
頁次 | 頁219-224 |
分類號 | 415.816 |
語文 | eng |
關鍵詞 | Anemia; Erythropoietin; Dialysis; Iron; |
中文摘要 | 人工合成紅血球生成素(rhEP0),現在已經很廣泛且成功地運用在治療腎性貧血的透析病患。雖然紅血球的造血反應和rhEPO的劑量有很大的正比直線相關性,但臨床我們仍可以看見一些病患對rhEPO的劑量需求有顯著的差別。因為 rhEPO 的價格昂貴,所以我們選擇一些長期血液透析臨床狀況平穩的病恩來評估影響 rhEPO 對紅血球造血反應的因素。四十一位每星期血液透析三次的病患列入研究。所有的病患皆在血液透析治療後給予 rhEPO 皮下注射,每週三次。所有病患在前四星期給予 rhEPO1,500u/ 次/人,如果病患的血色素增加 1.Og/dl 以上或血球比容積上昇 3% 以上則繼續給予 rhEPO1500u/次/人四星期。如果病患的血色素沒有增加 1.Og/dl 以上或血球比容積未上昇 3% 以上則該病患給予 rhEPO3,OOOu/次/人四星期。如果該病患仍未達到標準則給予 rhEPO4OOOu/次/人四星期。有七位病患退出此研究。二十六位病患在第一個四星期 rhEPO1,500u/次/人劑量下,其血色素增加 2.5g/dl 以上。八位病患中有七位在第二個四星期 rhEPO3OOOu/次/人劑量下,其血色索達到治療標準,但有一位病患在4,OOOu/次/人 rhEPO 劑量下,其血色素只增加不到 1.5g/dlo 對 rhEPO 造血反應較差的病患這一組八人,其血清鐵、鐵蛋白濃度及運鐵蛋白飽和指數 (transferrin saturation index) 較對 rhEPO 造血反應較好的病患這一組二十六人為低。但全鐵結合量 (total iron binding capacity) 則較高。我們評估這兩組病 患對 rhEPO 的造血反應,發現發病年齡、性別、原始腎病變、血中部甲狀腺濃度、尿素氮、肌肝酸、磷、鉀對 rhEPO 的造血反應並無差別。 |
英文摘要 | Recombinant human erythropoietin (rhEPO) has been successfully used in multicenter clinical trials with surprising results. Although the eryth ropoiesis is dose-dependent, the increase in hematocrit shows wide individual variations. We evaluated a group of stable hemodialysis patients who showed resistance. Forty-one patients were enrolled in this study. rhEPO was given subcutaneously three times a week. Initially, rhEPO 1,500 U was given for 4 weeks. If the hemoglobin Q3b) increased more than 1.0 g/dl or Hematocrit> 3%, patients were given the same dose for another 4 weeks. The patients who could not meet this criteria were given 3,000 U for another 4 weeks. After 4 weeks of treatment, the erythropoiesis reaction was reevaluated again following the criteria. The left poor responder was given rhEPO 4,000 U for further 4 weeks. Seven patients were dropped out. Twenty-six good responders showed a 2.5 g/dl or more Hb increment with rhEPO 1,500 U within the first 4 weeks. Seven of 8 poor responders had a 1.0 g/d1 or less increment during the first 4 weeks, but they responded to rhEPO 3,000 U in the second 4 weeks.The other poor responder had less than 1.5 g/dl on the dose of 4,000 U.The comparison of the poor responders group to the good responders group found the most preventing factor to be iron deficiency, which is indicated by low serum iron, ferritin levels, low transferrin saturation index and a high value of total iron binding capacity. The underlying renal diseases, sex, chronological age, duration on dialysis or serum parathyroid hormone levels were not significantly different between two groups. In summary, iron deficiency is the most important preventing factor in the initiation of rhEPO therapy in our study. |
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