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Clinical Research of Recombinant Human Erythropoietin in Treating the Cancer-related Anemia after Hemotherapy

目的:评价重组人红细胞生成素(Recombinant human erythropoietin injection, rHuEpo)治疗肿瘤化疗相关性贫血的疗效和安全性,以及对生存质量的影响。方法:采用随机分组方式,分为治疗组和对照组,分别于1～3周期化疗后6～24小时开始。治疗组(40例)行rHuEpo 治疗,150 U/kg皮下注射每周3次,疗程4～8周;对照组(24例)未用rHuEpo 治疗,其他治疗如中药及支持治疗两组均相同。所有64例患者若出现严重贫血则给予输血治疗,以保证化疗顺利进行。观察rHuEpo 对患者血红蛋白(Hb)、红细胞容积(Hct)、RBC、KPS评分、体重改善情况的影响以及rHuEpo 的毒副反应。结果:与对照组相比,治疗组治疗后Hb水平显著提高,8周有效率70%;2周内网织红细胞计数显著提高;应用无严重副反应发生,生存质量改善。结论:rHuEpo 治疗肿瘤化疗相关性贫血的疗效肯定,副反应少,能够改善患者生存质量。

Analysis of the clinical application of the reticulocyte parameters and different types of anemia in children

Objective To investigate the diagnostic value of the series parameters of reticulocyte in children with different types of anemia. Methods From January to August 2015, the reticulocyte parameters of 150 children with different types of anemia treated in the People’s Hospital of Dujiangyan were retrospectively analyzed. Another 150 healthy children aged 1-10 years examined in the same hospital at the same period were as the control group. Mindray BC-6900 automatic blood cell analyzer and suited reagent were used to determine the absolute value of reticulocyte (RET#), percentage of reticulocyte (RET%), immature reticulocyte ratio (IRF), low fluorescent intensity reticulocyte percentage (LFR%), moderate fluorescent intensity reticulocyte percentage (MFR%), and height fluorescent intensity reticulocyte percentage (HFR%). The data were statistically analyzed. Results Compared with the control group, RET%, RET# and IRF results in iron deficiency anemia group, hemolytic anemia group, aplastic anemia group, recent hemorrhagic anemia group, renal anemia group, leukemia and chemotherapy group had statistical difference (P<0.05). Compared with the control group, LFR%, MFR%, HFR% results in hemolytic anemia group and aplastic anemia group had statistical difference (P<0.05). LFR%, MFR% and HFR% results of other types of anemia had no statistical differences (P>0.05). Conclusion The series parameters of the reticulocyte, having an important reference value, can be used in the diagnosis of children with different types of anemia as a reference index, early diagnosis and early treatment of children with different anemia, which also can be used as a method to diagnose different types of anemia.

Clinical study of recombinant human erythropoietin combined with iron to correct perioperative anemia in elderly patients with intertrochanteric fractures

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.

地中海贫血并发慢性下肢溃疡两例

免疫功能紊乱相关的获得性单纯性红细胞再生障碍性贫血

【摘要】　单纯性红细胞再生障碍性贫血（pure red cell aplasia， PRCA）是临床相对罕见的一组异质性疾病，其中获得性PRCA发病原因多种多样。现就各种背景疾病下，免疫功能紊乱在PRCA发病机制中的作用进行探讨。

Influence of Blood Purification Modality on the Efficacy of Erythropoietin in Patients on Maintenance 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。

康复新对痔病继发贫血患者术后促愈作用及血红蛋白的影

目的分析评价康复新对痔病继发贫血患者术后的治疗效果。 方法将2008年1月－2014年10月60例痔病继发贫血患者及30例普通痔病患者分为3组，每组各30例。治疗组为贫血患者，术后加用康复新口服及创面坐浴；对照1组（贫血患者）及对照2组（非贫血患者）术后采取普通换药。比较3组患者的平均愈合时间，以及第10天和第20天贫血改善率。 结果治疗组平均愈合时间为（14.5±0.8）d，对照1组平均愈合时间为（21.0±1.4）d，对照2组平均愈合时间为（18.0±0.6）d，治疗组与对照1组和对照2组比较，差异有统计学意义（P＜0.05）。治疗组第10天血红蛋白（Hb）平均改善率为（44.82±19.45）%，第20天Hb平均改善率为（69.32±23.28）%，对照1组第10天Hb平均改善率为（16.27±13.31）%，第20天Hb平均改善率为（31.90±14.69）%，治疗组与同时期对照1组比较，差异有统计学意义（P＜0.05）。 结论康复新口服及创面坐浴对痔病继发贫血患者术后有更好的临床疗效。

地中海贫血并发胆源性急性胰腺炎一例

心脏瓣膜手术后并发溶血性贫血的治疗

目的 探讨心脏瓣膜手术后并发溶血性贫血的外科治疗方法及效果。方法 1998年1月至2007年12月，广东省人民医院广东省心血管病研究所共治疗11例心瓣膜手术后并发溶血性贫血患者，男9例，女2例；年龄15~57岁（40±14岁）。风湿性心瓣膜病6例，退行性心瓣膜病2例，先天性心瓣膜病2例，感染性心内膜炎1例。第一次手术：行二尖瓣置换术（MVR）2例，双瓣膜置换术（DVR）4例，二尖瓣人工瓣环成形术5例。第二次入院血红蛋白55~92 g/L（76±14 g/L），红细胞压积0.19~0.31（0.25±0.04），网织红细胞百分比0.08~0.17（0.12±0.04），总胆红素34.70~91.50 μmol/L（56.00±19.10 μmol/L），非结合胆红素23.40~54.90 μmol/L（38.60±12.30 μmol/L）。所有患者均先给予内科治疗，10例患者经内科治疗无效后再次行心瓣膜置换术或心瓣膜成形术治疗，另1例给予内科保守治疗。结果 再次手术治疗10例，术后死亡1例，死于溶血性贫血、肾功能衰竭和多器官功能衰竭；其他9例经再次手术治疗后痊愈出院，贫血症状消失，血常规检查正常。内科保守治疗治愈1例。随访10例，随访时间2个月至11年，心功能Ⅰ级8例，Ⅱ级2例，无晚期死亡。1例感染性心内膜炎患者出院时仍有轻度肾功能不全，随访3个月时肾功能完全恢复正常，随访1年心功能良好，无溶血症状。 结论 心瓣膜手术后并发溶血性贫血，如经内科治疗无效应尽早行再次心瓣膜手术治疗，可获得良好的效果。

Clinical characteristics and treatment of six kidney recipients with human parvovirus B19 infection

ObjectiveTo investigate the diagnosis, clinical features, treatment and outcome of pure red cell aplasia (PRCA) caused by human parvovirus B19 (HPV-B19) infection in kidney recipients. Method The clinical courses of six patients with PRCA caused by HPV-B19 infection after renal transplantation in West China Hospital between May 2018 and April 2019 were retrospectively investigated. Results The six patients showed obvious anemia symptoms, lacking rash, joint pain and other clinical symptoms of viral infection. The hemoglobin level of five patients got totally remission from a course of intravenous immunoglobulin (IVIG) treatment, and anemia symptoms like fatigue, weakness got notable improvement. One patient had no improvement after two courses of IVIG treatment, and his anemia was significantly improved after the third IVIG course combined with immunosuppressant conversion(from tacrolimus to cyclosporine), and one patient with recurrence accepted a repeated course of IVIG treatment and obtained remission of severe anemia again. The median time of reticulocyte firstly rose to above 0.084×1012/L from the day of IVIG treatment ended was 3.50 (1.25, 5.00) days, and the median time required for a 30 g/L increase in hemoglobin to the end of IVIG treatment was 16.00 (9.25, 31.25) days. No serious adverse reactions occurred and all patients had stable graft function. Conclusions The main clinical manifestations of PRCA caused by HPV-B19 infection after kidney transplantation are anemia symptoms, lacking other clinical symptoms of viral infection. HPV-B19 DNA detection combined with blood routine examination, reticulocyte count and bone marrow cytology (or none) can diagnose HPV-B19 infection. High dose of IVIG is effective and safe, and a repeated course is still effective when the infection recurs. For refractory PRCA that IVIG monotherapy fail, a combination with conversion from tacrolimus to cyclosporine can effectively improve the anemia without graft dysfunction.