重组人红细胞生成素治疗化疗相关性贫血的疗效观察

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.方法 化疗相关性贫血的患者36例,其中21例行rHuEPO治疗,用法为:150 u/kg·次,皮下注射3次/周,疗程418周,同时给予中药及支持治疗.15例未用rHuEPO治疗.所有36例患者若出现严重贫血则给予输血治疗,以保证化疗继续进行.观察rHuEPO对血红蛋白(Hb)、红细胞比容(Hct)等的影响,以及对患者生活质量的影响和副反应.结果 治疗组治疗后Hb水平显著提高,4周有效率66.7%,对照组无明显提高;治疗组治疗后两周内网织红细胞计数显著提高,对照组治疗前后无变化.应用rHuEPO无严重副反应发生,安全性高,患者生活质量有所改善.结论 rHuEPO治疗肿瘤化疗相关性贫血的疗效肯定.rhuEPO不仅有效提高Hb水平,而且安全性高,副反应少,能够改善患者生存质量.     

重组人促红素联合蔗糖铁治疗胃癌术后缺铁性贫血的疗效观察

目的探讨重组人促红素(EPO)联合蔗糖铁治疗胃癌术后贫血的疗效和安全性。方法将2012年1月至2016年9月鹰潭市人民医院普外科胃癌术后合并缺铁性贫血患者58例分为单用蔗糖铁(单用组)患者28例和EPO联合蔗糖铁(联合组)患者30例。EPO采用10 000 IU,每周3次皮下注射,蔗糖铁采用静脉滴注400 mg,每2周1次,共4周,记录用药前后红细胞计数(RBC)、血红蛋白(HGB)、红细胞比容(HCT)、血清铁蛋白(SF)、转铁蛋白饱和度(TS)变化。同时记录用药过程及用药后不良反应发生率。结果治疗后两组患者HGB较治疗前明显升高,差异有统计学意义(P0.05);单用组总有效率71.43%,显效率28.57%,联合组总有效率83.33%,显效率50.00%,联合组有效率及显效率明显提高,差异有统计学意义(P=0.000,P=0.003)。结论 EPO联合蔗糖铁治疗胃癌术后缺铁性贫血疗效确切,可有效改善贫血症状,安全性可控。     

重组人红细胞生成素治疗放化疗诱发的贫血

[目的]研究重组人红细胞生成素(recombinanthumanerythropoietin,rHuEPO)治疗肿瘤化疗联合体部伽玛刀诱发贫血的疗效及安全性。[方法]45例化疗联合伽玛刀治疗诱发贫血的患者随机分为rHuEPO治疗组和对照组,两组具有可比性。治疗组给予EPO10000U,1次/隔日,皮下注射。连续用药6周,并于用药后1周开始加用硫酸亚铁300mg,口服,3次/日,对照组不给EPO,其它治疗相同。观察EPO对血红蛋白、输血、生活质量的影响及副反应。[结果]治疗组血红蛋白平均提高20.1g/L,而对照组下降9.8g/L(P<0.001)。治疗组KPS评分提高,而对照组则下降。EPO应用副反应少,耐受性好。[结论]摇rHuEPO治疗肿瘤化放疗诱发贫血是一个安全、有效的药物,提高血红蛋白水平,改善生活质量。     

重组人红细胞生成素改善肿瘤患者放化疗相关性贫血临床观察

贫血是癌症患者常见的并发症，约50％的肿瘤患者发生贫血，晚期及接受放化疗患者因骨髓造血系统进一步抑制，贫血发生率高达90％，严重影响患者对放化疗的耐受性及生活质量。本研究应用重组人红细胞生成素（rHuEPO）治疗放化疗相关性贫血取得较好疗效。     

重组人红细胞生成素治疗20例含顺铂化疗诱发的贫血

目的研究重组人红细胞生成素(rHuEPO)治疗肿瘤化疗诱发贫血的疗效及安全性.方法 采用随机的方法将41例肿瘤伴化疗诱发贫血的患者分为EPO治疗组和对照组,两组具有可比性,治疗组给予EPO 150 u/(kg*次),5次/周,皮下注射,连续用药8周,并于用药后1周开始加用铁剂速力菲100 mg口服,3次/d .对照组不给予EPO,其他治疗同治疗组.观察EPO对血红蛋白水平、输血情况及生活质量的影响及副反应.结果①治疗组血红蛋白水平治疗后平均提高23.0 g/L,而对照组反而下降10.7 g/L(P<0.001),治疗组生活质量KPS评分治疗后平均提高6.50,而对照组反而下降9.30(P<0.001) ②治疗组与对照组在治疗后的输血率和输血量相比较差异无显著性③应用重组人红细胞生成素的副反应少,耐受性好.结论rHuEPO对肿瘤化疗诱发贫血是一个安全有效的用药,不仅能提高Hb水平,而且能改善患者生活质量,值得我们进一步推广和扩大应用.     

重组人促红细胞生成素联合蔗糖铁治疗肿瘤相关性贫血的临床疗效

目的研究重组人促红细胞生成素(rhEPO)联合蔗糖铁治疗肿瘤相关性贫血(CRA)的临床疗效。方法选取2017年6月至2018年6月我院收治的36例CRA患者,随机将患者分为蔗糖铁组与rhEPO组,每组18例。其中蔗糖铁组患者采取蔗糖铁治疗,rhEPO组患者采取rhEPO联合蔗糖铁治疗,比较治疗前后2组患者血红蛋白(Hb)、红细胞压积(Hct)、网织红细胞(Ret)水平的变化,临床疗效,不良反应。结果治疗总有效率rhEPO组为94.44%,高于蔗糖铁组的72.22%,差异有统计学意义(χ^(2)=4.433,P=0.035)。与治疗前相比,治疗后蔗糖铁组和rhEPO组患者的Hb、Hct和Ret水平均明显升高,差异均有统计学意义(蔗糖铁组t=42.848,P<0.001;t=24.674,P<0.001;t=25.796,P<0.001;rhEPO组t=35.990,P<0.001;t=26.889,P<0.001;t=71.451,P<0.001);rhEPO组治疗后的Hb、Hct、Ret水平均明显优于蔗糖铁组,差异均有统计学意义(t=7.348,P<0.001;t=11.338,P<0.001;t=63.065,P<0.001)。2组不良反应总发生率比较差异无统计学意义(χ^(2)=0.000,P=1.000)。结论rhEPO联合蔗糖铁能快速提高CRA患者Hb水平,改善肿瘤患者贫血症状,而且不增加不良反应发生风险。     

重组人红细胞生成素治疗化疗相关性贫血的疗效观察

目的评价重组人红细胞生成素(rHuEPO)治疗肿瘤化疗相关性贫血的疗效和安全性.方法将36例恶性实体瘤伴化疗相关性贫血的患者,随机分成两组,治疗组给予EPO,150u/kg@次,3次/周,皮下注射,连续用药8周.同时口服硫酸亚铁100mg,3次/日.对照组不给予EPO,仅同剂量口服硫酸亚铁.观察EPO对血红蛋白(Hb)水平,网织红细胞计数,生活质量的影响及副反应.结果①治疗组治疗后Hb水平平均提高21g/L;对照组治疗后反而下降8.6gL(P＜0.001).②治疗组治疗后两周内网织红细胞计数均值提高4.1%(P＜0.001);对照组治疗前后无变化.③应用EPO副反应少,安全性好.结论应用EPO不仅有效提高Hb水平,改善患者生存质量,而且副反应少,值得我们应用于临床.     

蔗糖铁注射液治疗肿瘤相关性贫血的前瞻性随机对照研究

目的比较蔗糖铁（森铁能）静脉注射与口服琥珀酸亚铁薄膜衣片（速力菲）治疗恶性肿瘤患者缺铁性贫血的疗效与安全性。方法采用前1性、随机对照研究,将60例恶性肿瘤患者随机分为两组。实验组（蔗糖铁）：将100-200 mg蔗糖铁稀释于生理盐水100 ml,每周2-3次,连续应用4周。对照组（琥珀酸亚铁薄膜衣片）：一次0.2 g,一日3次。全部病例都合并使用红细胞生成素（EPO）治疗。观察并比较两组患者治疗贫血的效果、铁代谢指标变化及不良反应发生情况。结果经治疗后,试验组与对照组的Hb均较治疗前显著升高,Hct也较治疗前明显升高,而试验组的上升幅度大于对照组（P〈0.05）。治疗后两组铁蛋白和转铁蛋白饱合度均明显高于治疗前,试验组的上升幅度大于对照组（P〈0.05）。两组患者均无严重不良反应发生。结论蔗糖铁是治疗伴有缺铁的恶性肿瘤患者相关性贫血的一种安全而有效的药物。     

血速升颗粒联合铁剂治疗胃癌切除术后贫血的疗效及安全性比较

目的评价血速升颗粒联合蔗糖铁治疗胃癌切除术后合并缺铁性贫血患者的疗效及安全性。方法选取胃癌手术后合并缺铁性贫血的患者98例随机分为联合组和单药组,两组患者术后均给予蔗糖铁治疗,联合组加用血速升颗粒,比较治疗前后贫血指标的变化及药物不良反应情况。结果治疗后,联合组血红蛋白含量、红细胞压积、血清铁蛋白水平等较单药组增高,且差异有统计学意义。联合组治疗贫血总有效率及显效率高于单药组,且差异均有统计学意义。两组治疗后,中医症状记分均较治疗前减小。用药过程中,两组不良反应比较,差异无统计学意义。结论血速升颗粒联合蔗糖铁治疗可改善胃癌手术后合并缺铁性贫血患者的血红蛋白含量、红细胞压积、红细胞平均血红蛋白量、血清铁蛋白水平,并可改善贫血症状,较单用蔗糖铁效果更佳,且联合用药不增加不良反应发生率。     

重组人红细胞生成素治疗乳腺癌化疗相关性贫血的临床研究

目的：评价重组人红细胞生成素（rhEPO）治疗乳腺癌化疗相关性贫血的疗效和安全性。方法将100例乳腺癌化疗相关性贫血患者随机分为对照组和治疗组,对照组50例患者仅予铁剂,治疗组50例患者在对照组治疗的基础上给予rhEPO治疗。治疗8周后观察两组患者血红蛋白、红细胞比容,异体输血需求率及患者生存质量。结果治疗组血红蛋白水平及红细胞比容分别由治疗前的（92.2±10.8）g/L和（27.4±4.5）%升至治疗后8周的（115.4±10.6）g/L和（35.5±5.8）%,对照组血红蛋白水平及红细胞比容分别由治疗前的（94.1±5.6）g/L和（27.7±4.6）%降至治疗后8周的（84.8±8.6）g/L和（22.7±3.8）%。对照组的输血需求率为26.0%（13/50）,高于治疗组的10.0%（5/50）,差异有统计学意义（P﹤0.05）。治疗组与对照组相比患者生活质量明显提高,4周有效率分别为56.0%和8.0%,8周后有效率分别为90.0%和24.0%,治疗组均高于对照组,差异有统计学意义（P﹤0.05）。两组不良反应发生情况比较,差异无统计学意义（P﹥0.05）。结论 rhEPO治疗乳腺癌化疗相关性贫血的疗效肯定,安全性高,能够改善患者生存质量。     

Role of iron in optimizing responses of anemic cancer patients to erythropoietin

Approximately 50% of cancer patients develop anemia. In the past, the only available treatment option for these patients was transfusion. Since the late 1980s, recombinant human erythropoietin (rHuEPO, epoetin alfa [Epogen, Procrit]) has provided a treatment alternative. Controlled clinical trials have shown that rHuEPO increases hemoglobin and hematocrit levels and reduces the need for transfusions in patients with cancer-related anemia. These controlled trials have suggested (as larger, uncontrolled studies) that the improvements in hemoglobin are associated with increases in energy level, functional status, and overall quality of life. However, only about 50% of patients respond adequately to usual doses of rHuEPO. In the chronic renal failure population, functional iron deficiency is the most common cause of inadequate response to rHuEPO. It has been hypothesized that functional iron deficiency may also occur in cancer patients receiving rHuEPO and may account for the lack of response in up to half of those patients. Studies in renal failure patients have shown that administration of intravenous iron can correct functional iron deficiency more effectively than oral iron and may improve response to rHuEPO. Intravenous iron also reduces the total amount of rHuEPO needed to normalize hematocrit and hemoglobin levels, thereby reducing treatment costs. Ongoing clinical trials are evaluating whether IV iron can also improve rHuEPO responsiveness in patients with cancer-related anemia.     

肿瘤患者化疗相关性贫血的治疗

目的研究我科肿瘤患者贫血的发生情况及化疗相关性贫血的药物干预治疗,及对癌因性疲劳及生活质量的影响。方法收集我科2007年8月～2008年11月肿瘤患者的病例资料,统计贫血的发生率,贫血的程度,与化疗的关系等,对于化疗相关性贫血患者,给予皮下注射重组人红细胞生成素注射液或合并静脉补充铁剂,8周后复查血常规,评价治疗效果并比较治疗前后对癌因性疲劳及生活质量的影响。治疗前后通过患者填写简明疲劳症量表和生活质量测定量表评价治疗前后对癌因性疲劳及生活质量的影响。结果84例肿瘤患者贫血的发生率为83.33%, 其中轻度贫血26人（30.95%),中度贫血26人(30.95%),重度贫血13人(15.48%),危及生命的贫血5人(5.95%),无贫血14人(16.67%),对于化疗相关性贫血患者经治疗后血红蛋白平均升高（21.2±3.3）g/L。皮下注射重组人红细胞生成素注射液合并静脉补充铁剂组血红蛋白增高与单纯皮下注射重组人红细胞生成素注射液组比较有统计学意义。治疗前后疲劳症状量表及生活质量自评量表表明患者癌因性疲劳及生活质量明显改善。结论肿瘤患者合并贫血发生率高,尤其合并化疗者,严重影响患者生活质量,及时发现并纠正化疗相关性贫血能明显改善患者的生存质量,皮下注射重组人红细胞生成素注射液合并静脉补充铁剂能有效改善化疗相关性贫血。     

血清EPO及sTfR水平与恶性肿瘤性贫血的相关性研究

目的探讨血清促红细胞生成素（erythropoietin,EPO）、可溶性转铁蛋白受体（soluble transferrin receptor,sTfR）水平和癌性贫血之间的关系,为临床合理使用重组人红细胞生成素（Recombinant Human Erythropietin,r-HuEPO）和铁剂治疗癌性贫血提供理论依据。方法采用酶联免疫分析方法（ELISA）测定60例癌性贫血患者血清EPO水平和sTfR水平,并将其与52例非癌性贫血患者的测定值及20例正常对照进行比较,以直线相关分析sTfR、EPO水平和Hb之间的关系。结果癌性贫血患者血清EPO、sTfR均较正常对照显著升高（P〈0.01）;癌性贫血患者血清EPO显著高于非癌性贫血患者（P〈0.05）;癌性贫血患者sTfR高于非癌性贫血患者,差异无显著性（P〉0.05）;癌性贫血患者血清EPO、sTfR升高的程度与贫血严重程度一致,与Hb值存在负相关,但与病期无明显相关性;EPO和sTfR之间无相关性。结论恶性肿瘤患者的血清EPO和sTfR水平能较好地反映其贫血病因,对贫血的治疗以及预后判断有一定的临床参考价值。     

Erythropoietin restores the anemia-induced reduction in cyclophosphamide cytotoxicity in rat tumors

The aim of this study was to examine the impact of anemia prevention by recombinant human erythropoietin (rHuEPO) treatment on the cytotoxicity of cyclophosphamide in solid experimental tumors. Anemia was induced using a single dose of carboplatin (50 mg/kg i.v.) resulting in a long-lasting reduction (30%) of the hemoglobin concentration. In a second group, the development of anemia was prevented by rHuEPO (1000 IU/kg) administered s.c. three times/week starting 7 days before carboplatin application. Four days after carboplatin treatment, tumors (DS-sarcoma of the rat) were implanted s.c. onto the hind food dorsum. Neither carboplatin nor rHuEPO treatment influenced tumor growth rate per se. When tumors were treated with a single dose of cyclophosphamide (60 mg/kg i.p.) 5 days after implantation, a growth delay with a subsequent regrowth of the tumors was observed. In the anemia group, the growth delay was significantly shorter compared with nonanemic controls (13.3 days versus 8.6 days). In the group where anemia was prevented by rHuEPO treatment, growth delay was comparable with that of nonanemic controls (13.3 days). These results suggest that chemotherapy-induced anemia reduces cytotoxicity of cyclophosphamide in tumors, whereas correction of anemia by rHuEPO treatment (epoetin alpha) increases the sensitivity, probably as a result of an improved oxygen supply to tumor tissue.     

肿瘤相关性贫血铁代谢状况与生活质量的相关性研究

目的：探讨血清铁、铁蛋白和转铁蛋白测定联合生活质量评分在不同程度肿瘤相关性贫血患者中的变化情况。方法：采用放射免疫分析（ＲＩＡ）测定血清铁蛋白水平,免疫散射浊度法定量测定血清转铁蛋白含量,亚铁嗪终点比色法测定血清铁。采用生活质量评分表进行生活质量调查。结果：血清铁水平在中度贫血组与无贫血组的差异有显著性（Ｐ＜０.０５）;生活质量评分在各程度贫血组与无贫血组的差异均有显著性（Ｐ＜０.０５）,中、重度贫血组与轻度贫血组比较,中度与重度贫血组比较,差异均有极显著性（Ｐ＜０.０１）;而铁蛋白、转铁蛋白在各组间无差异。结论：肿瘤患者的贫血愈重,血清铁愈低,生活质量评分愈低。因此恶性肿瘤贫血除治疗原发病外,应重视纠正贫血,以提高肿瘤患者生活质量。     

Cost-effectiveness of recombinant human erythropoietin in the prevention of chemotherapy-induced anaemia.

Recombinant human erythropoietin (rHuEPO) has been advocated for the treatment of anaemia in patients submitted to cancer chemotherapy. We used decision analysis to compare the cost-effectiveness of rHuEPO supplemented with red blood cell (RBC) transfusions with conventional treatment with RBC transfusions alone. At baseline, we analysed the use of rHuEPO as secondary prophylaxis according to effectiveness estimates from a community-based oncology study. In order to reduce the probability of transfusions from 21.9% to 10.4%, and the number of RBC units per patient per month from 0.55 to 0.29, 150 units kg(-1) s.c. rHuEPO three times per week for 4 months resulted in an incremental cost of $189,652 per quality-adjusted life year (QALY). In patients treated with cisplatin-containing chemotherapy, rHuEPO added $190,142 per QALY. In a hypothetical scenario of a transfusion pattern that maintained the same haemoglobin level of rHuEPO-responsive patients, the marginal cost of rHuEPO was always greater than $100,000 per QALY. Results were stable with regard to variations in the probability of blood-borne infections, quality of life of responding patients and cancer-related mortality. The additional cost could be lowered to less than $100,000 per QALY by saving 4.5 RBC units over 4 months for any patient treated. In conclusion, according to current use, rHuEPO is not cost-effective in the treatment of chemotherapy-induced anaemia. More tailored utilization of the drug and better consideration of predictive response indicators may lead to an effective, blood-sparing alternative.     

Approaches to anemia, thrombocytopenia, and DIC in cancer patients

Patients with cancer-related anemia have an inadequate Epo response that is further impaired by cancer treatments such as chemotherapy. Significant number of studies have demonstrated that treatment of anemia in cancer patients using recombinant human EPO(rHuEPO, epoetin alfa) significantly increases hemoglobin(Hb) levels,reduces transfusion requirements,and improves quality of life,particularly by relieving fatigue. However,the findings of several studies have raised the possibility of an adverse effect of thromboembolism. The American Society of Clinical Oncology and the American Society of Hematology developed an evidence-based clinical practice guideline for the use of epoetin in patients with cancer. In cancer patients, the risk of bleeding depends not only on the platelet count, but also on the underlying disease, in accordance with coagulation defects. The cause of thrombocytopenia must be established prior to platelet transfusion since platelet transfusions may be relatively contraindicated in certain conditions e. g., heparin-induced thrombocytopenia(HIT), and thrombotic thrombocytopenic purpura/hemolytic uremic syndrome(TTP/HUS).     

Erythropoietin treatment for chronic anemia of selected hematological malignancies and solid tumors

BACKGROUND: Neoplasias, especially in their more advanced stages, are oftenassociated with chronic anemia of malignancy which impairs thepatient's physical ability and quality of life PATIENTS AND METHODS: Forty-two patients with chronic anemia associated with hematologicalmalignancies (18 multiple myelomas, 10 myelodysplastic syndromes)or solid tumors (9 breast cancers, 5 colon cancers) were treatedwith 150–300 units/kg rHuEPO for a median time periodof 16 weeks. Response was defined as an increase of the initialhemoglobin level by at least 2 g/dl. RESULTS: The response rates for solid tumors were comparable (44.4% and40% for breast cancer and colon cancer, respectively), whilstthe response in patients with hematological malignancies dependedstrongly on the disease entity (77.8% for multiple myeloma,10% for myelodysplastic syndrome). Pretreatment serum levelsof endogenous erythropoietin (EPO) were significantly higherin non-responding patients than in responders. During rHuEPOtherapy, EPO levels in non-responders increased even further,while they remained basically unchanged in responding patients.In responders, the WHO performance status before the start ofrHuEPO therapy was more favorable and showed impressive improvementduring the course of treatment. The median survival time ofresponders was 28.0 months as compared to only 9.2 months fornon-responders. Clinical symptoms of anemia subsided or at leastconsiderably improved under successful rHuEPO therapy. Withthe exception of occasional flu-like symptoms, no undesirableeffects of rHuEPO treatment were observed. CONCLUSIONS: In conclusion, rHuEPO treatment corrected anemia of malignancyboth in patients with hematologic disease and in those withsolid tumors, but responsiveness varied considerably amongstthe different disease entities. chronic anemia of cancer, erythropoietin levels, erythropoietin treatment