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題 名 | 紅血球生成素1998=Erythropoietin (EPO) 1998 |
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作 者 | 鄭書建; 蔡敦仁; | 書刊名 | 內科學誌 |
卷 期 | 9:4 1998.12[民87.12] |
頁 次 | 頁184-196 |
分類號 | 415.816 |
關鍵詞 | 紅血球生成素; 腎性貧血; 鐵缺乏; Erythropoietin; EPO; Renal anemia; Iron deficiency; |
語 文 | 中文(Chinese) |
中文摘要 | 紅血球生成素(Erythropoietin, EPO)的發現及其在腎性貧血的應用是近年來對慢 性腎衰竭治療發展的重大突破之一。EPO 主要在腎臟中腎小管周圍的纖維母細胞製造,經由 血流到達骨髓中,刺激大量紅血球的生成。 給予 EPO 可使大部份慢性腎衰竭病人的貧血獲 得明顯改善,也可增進心臟功能與生活品質,並減少其對輸血的需求。美國國家腎臟基金會 -1997 年的透析療效品質指導 (National Kidney Foundation-Dialysis Outcome Quality Initiative 1997,簡稱為 NKF-DOQI 1997) 對 EPO 治療有以下的建議:Hct 目標值應定在 33 ∼ 36 %, 給予 EPO 應由 80 ∼ 120 單位 / 公斤 / 週 (一般是 6000 單位 / 週 ) 分為每週 2 ∼ 3 次皮下注射開治,之後再依據反應來做調整。 對 EPO 治療反應不佳最常 見的原因是鐵缺乏, 對接受 EPO 治療者建議的鐵質狀態為血清鐵蛋白 (serum ferritin) 大於 100 ng/ml,且運鐵蛋白飽和度 (transferrin saturation) 大於 20 %。大部份血液 透析病人需要靜脈注射鐵劑來達到和維持足夠的鐵質狀態,口服鐵劑則建議用於對靜脈注射 鐵劑過敏者、腹膜透析及未開始透析之病人。EPO 在臨床使用上曾報告過一些可能的副作用 , 例如高血壓、痙攣與血管通路栓塞等,但最近認為這些並不與使用 EPO 有直接的關係。 EPO 也嘗試應用於非腎性貧血的治療。由分子生物學的技術來合成 EPO 以及利用 EPO 基因 傳遞應用於臨床治療等方面,是未來對 EPO 的展望。 本文並介紹臺大醫院血液透析病人使 用 EPO 的治療經驗,也提出幾個對 EPO 反應不佳的實例以供參考。 |
英文摘要 | One of the major recent breakthroughs in the treatment of chronic renal failure (CRF) was the discovery of human erythropoietin (EPO) and its success in treating renal anemia. EPO is produced predominantly in peritubular cortical fibroblasts of kidney, and reaches bone marrow through the blood stream, functions as an essential growth and survival factor for the late erythroid precursor cells. With availability of EPO, the renal anemia is much improved in most CRF patients. In the same time, the improved cardiac function and quality of life, and a reduced need for blood transfusions are also the benefits of EPO therapy. In 1997, the National Kidney Foundation's Dialysis Outcome Quality Initiative (NKF-DOQI) clinical practice guidelines for the treatment of anemia of CRF suggested EPO therapy as following: (1). The target range for hematocrit (Hct) should be 33 ∼ 36%, (2). When EPO is given initially to adult patients, the dose should be 80 ∼ 120 units/kg/wk (typically 6000 units/wk)in 2 ∼ 3 doses per week subcutaneously, and it should be titrated according to the Hct change then. By far the most important cause for a poor response to EPO therapy is iron deficiency. For the CRF patients receiving EPO therapy, the guidelines suggested that sufficient iron status should be maintained a serum ferritin level of ≧ 100 ng/ml, and a transferrin sataration (TSAT) of ≧ 20%. Most hemodialysis patients will require intravenous iron for achieve and maintain a sufficient iron status. Oral iron is acceptable for patients who is allergy to intravenous iron dextran, and for peritoneal dialysis, and pre-dialysis patients. Some possible adverse effects related to EPO therapy, such as hypertension, seizures and access thrombosis etc., has been reported. However, there is no direct evidences of an increase risk of the above complications in EPO therapy. The success in treating renal anemia has led to attempts to use EPO for the stimulation of erythropoiesis in patients with other forms of anemia. Future research concentrates on the development of using molecular biology techniques to synthesize small peptides (EPO mimetics) , which are able to activate the EPO receptors. Furthermore, gene therapy might offer next breakthrough in the treatment of renal anemia in another ten years. We also introduce the experience of EPO treatment in chronic hemodialysis patients at National Taiwan University Hospital. And several cases of poor response to EPO therapy are presented and discussed in this article. |
本系統中英文摘要資訊取自各篇刊載內容。