Studies of evidence-based medicine have provided much important evidence, clarified problems, and guided the clinical practice in the treatment of renal diseases. As examples, several therapeutic problems in renal hypertension, renal anemia and low protein diet for the patients with chronic kidney disease are discussed in this paper.
Objective To assess the effectiveness and safety of erythropoietin (EPO) for cancer-related malignant anemia without radiotherapy or chemotherapy. Methods Randomized controlled trials (RCTs) or quasi-randomized controlled trials (quasi-RCTs) involving erythropoietin in the treatment of cancer-related malignant anemia were searched and identified from PubMed (1966 to Sept. 2009), EMBASE (1974 to Sept. 2009), The Cochrane Library (Issue 3, 2009), CBM (1978 to Sept. 2009), CNKI (1994 to Sept. 2009), VIP (1989 to Sept. 2009). We also handsearched relevant journals. Data were extracted and evaluated by two reviewers independently with specially designed extraction form. We evaluated the quality of the included studies by the Cochrane Handbook 5.0 recommend standard and analyzed data by Cochrane Collaboration’s RevMan 5.0. Results We included twelve trials. The quality of the included studies was poor. The grade of ten studies was B, and the grade of two studies was C. Meta-analyses showed that there were significant differences between erythropoietin and blank in volume of blood transfusion [SMD= –0.66, 95%CI (–1.14, –0.17), P=0.008], number need to transfusion [OR=0.60, 95%CI (0.39, 0.92), P=0.02], and the change of hemoglobin after two-week therapy [SMD=2.40, 95%CI (0.29, 4.52), P=0.03]. Conclusion The current evidence shows that EPO significantly benefits cancer-related malignant anemia. Well-designed RCTs with a larger sample size, longer intervention and follow-up periods are still needed.
COPD 是一种可预防、可治疗, 以气流不完全可逆受限并呈进行性发展为特征的疾病, 与肺部对有害气体或有毒颗粒的异常炎症反应有关。在全球范围内COPD 是引起死亡和功能致残的主要疾病之一。COPD 在全球患病率和死亡率位居第四, 并呈不断上升的趋势[1] 。本病具有明显的肺外效应, 包括引起全身系统性炎症、代谢改变、神经激素激活,以及对肌肉骨骼、心血管系统等其他系统的影响等[2] 。既往认为COPD 仅引起红细胞增多, 但近期研究发现COPD 引起的系统性炎症可影响红细胞的生成, 贫血亦同样存在于部分COPD 患者。目前认为, COPD导致的贫血与其他许多慢性疾病如慢性心衰一样, 同属于一种慢性病性贫血( anemia of chronic disease, ACD) , 称为COPD 相关性贫血, 其患病率高于继发性红细胞增多症在COPD 的患病率[3-5] 。本文就COPD 相关性贫血的流行病学概况、病理生理机制、临床重要性及干预的最新研究进展如下综述。
【Abstract】 Objective To report 1 case of acute hemolytic anemia after liver transplantation because of ABO compatibility and therapeutic experience. Methods The patient with liver cancer underwent orthotopic piggyback liver transplantation on September 2010 after radiofrequency ablation of the tumors. The donor and recipient ABO blood types were type O and type A, separately. Acute hemolytic anemia occurred at 10 days after transplantation and hemoglobin decreased to 56 g/L. The bone marrow showed active hyperplasia; and myeboid∶erythroid was 0.52∶1. The immunosuppressants were used and type O washed red blood cells were transfused immediately. Results The general condition of the patient was improved; hemoglobin increased gradually and returned to 111 g/L at 34 days after liver transplantation. At 12 months of follow-up, hemoglobin was within normal range. Conclusion Using graft blood type washed red blood cells transfusion and immunosuppressants could be an effective therapeutic procedure in the patient with ABO compatility graft when acute hemolytic anemia occurrs.
【摘要】 目的 比较生血宁片和多糖铁复合物胶囊两种口服铁剂在治疗维持性血液透析患者肾性贫血中的治疗效果。 方法 2008年12月-2010年6月间选择40例维持性血液透析贫血患者，随机分为生血宁片组和多糖铁复合物胶囊组，每组20例，观察期为8周。分别检测两组患者用药前及用药后4、8周时血红蛋白、红细胞压积、血清铁蛋白、转铁蛋白饱和度等指标情况。同时两组患者均使用基因重组人促红细胞生成素，按100~120 U/（kg·周），分两次皮下注射。 结果 治疗前两组指标无明显差异，治疗后两组患者的血红蛋白、红细胞压积、血清铁蛋白以及转铁蛋白饱和度较治疗前均显著上升，且两组患者升高的幅度相比，生血宁组升高的幅度更显著。治疗结束时，两组患者不良反应方面的差异无统计学意义。 结论 两种口服铁剂均能有效地纠正血液透析患者的铁缺乏及贫血状况；生血宁片组的作用更显著，且还具备降低患者促红细胞生成素使用量的作用。【Abstract】 Objective To compare the effect of Shengxuening piece and capsule polysaccharide-iron complex on anemia in hemodialysis patients. Methods A total of 40 patients with anemia in maintenance hemodialysis treated between December 2008 and June 2010 were randomly divided into Shengxuening piece group and capsule polysaccharide-iron complex group; the patients were observed for 8 weeks. Hemoglobin (Hb), hematocrit (Hct), serum ferritin (SF), transferrin saturation (TSAT) and other indicators were detected before treatment four and eight weeks after the treatment. While patients were used recombinant human erythropoietin (EPO) according to 100-120 U/(kg·week), twice subcutaneous injection. Results Before treatment, there was no significant difference between the two groups. Hb, Hct, SF and TSAT increased significantly after treatment in both of the groups and specially in the Shengxuening piece group. After the treatment, the difference in the adverse reaction between the two groups was not significant. Conclusions Both oral iron can effectively correct the hemodialysis patients with iron deficiency and anemia. However, Shengxuening has more significant role and may reduce the use of erythropoietin in patients with hemodialysis.
目的 通过比较三种血液净化方式对炎症介质、甲状旁腺激素等中大分子毒素的清除效果，并观察促红细胞生成素（EPO）的治疗效果，探寻有利于肾性贫血改善的最佳透析模式。 方法 2011年5月－8月采用前瞻性、随机对照、开放式设计，选择维持性血透患者60例，随机分成3组，每组20例。血液灌流（HDP）组[每2周5次血液透析（HD）+1次HDP]、血液透析滤过治疗（HDF）组（每2周5次HD+1次HDF）、HD组（每2周6次HD），随访3个月。检测试验前后反应蛋白（CRP）、β2微球蛋白、甲状旁腺素（PTH）、白介素-6的水平以及各组患者肾性贫血指标的变化。 结果 3个月试验结束时，HDP组和HDF组4项尿毒症毒素水平均显著下降，其中HDP组CRP水平明显低于HDF组（P＜0.05）；HDP组和HDF组试验后的血红蛋白水平较试验前升高，ERI值下降。HD组试验前后的毒素水平无明显变化，ERI值升高。3组患者均未出现严重不良事件。 结论 HDP和HDF清除中大分子毒素的能力优于HD，有利于缓解微炎症状态，改善EPO治疗效果。HDP和HDF的远期效果哪种更好，尚有待于进一步的研究。
Objective To investigate the effectiveness of recombinant human erythropoietin (rHuEPO) combined with iron in treatment of anemia in elderly patients with intertrochanteric fractures during perioperative period. Methods A clinical data of 71 patients with intertrochanteric fractures met the inclusion criteria between April 2016 and October 2017 was retrospectively analyzed. All patients were treated with closed reduction and proximal femoral intramedullary nail fixation. Thirty-one patients were treated with rHuEPO and iron before operation as trial group, and 40 patients were not treated with rHuEPO and iron as control group. There was no significant difference in gender, age, body mass index, cause of injury, fracture side and classification, American Society of Anesthesiologists (ASA) classification, combined medical diseases, time from fracture to admission, preoperative hospital stay, and operation time between the two groups (P>0.05).The hemoglobin levels before operation and at 1, 3, and 7 days after operation, number of blood transfusion, blood transfusion rate, blood transfusion volume, postoperative hospital stay, complications were recorded and compared. Results After operation, 8 patients (25.8%) in trial group and 22 patients (55.0%) in control group received blood transfusion; the blood transfusion volume was (1.96±0.85) units in trial group and (3.19±1.61) units in control group. There were significant differences in blood transfusion rate and volume between the two groups (P<0.05). There was no significant difference in preoperative hemoglobin level between the two groups (P>0.05). The postoperative hemoglobin level was higher in trial group than in control group, and the difference between the two groups was significant at 7 days (P<0.05). The postoperative hospital stay was (6.16±3.97) days in trial group and (9.25±4.47) days in control group, showing significant difference between the two groups (P<0.05). There were 8 patients (25.8%) with pulmonary infection in trial group and 14 (35.0%) in control group after operation; 6 patients (19.4%) with deep venous thrombosis in trial group and 8 (20.0%) in control group. There was no significant difference in the incidences of complications between the two groups (P>0.05). All patients were discharged from hospital normally, and no one died during hospitalization. Conclusion The application of rHuEPO combined with iron before operation in elderly patients with intertrochanteric fractures can rapidly increase the hemoglobin level after operation, shorten the hospital stay, and do not increase the risk of deep venous thrombosis after operation.