- 期刊
慢性腎臟病貧血診斷與治療的新進展
Anemia of Chronic Kidney Disease: Diagnostic Tool and Treatment Update
摘要
貧血好發於慢性腎臟病患者，治療以紅血球生成素（erythropoietin, EPO）及鐵劑補充為主。除了因為飲食攝入不夠、腸胃道流失、或透析過程造成血液流失等，會造成絕對鐵質缺乏外，因長期處於慢性發炎，細胞激素會刺激hepcidin的分泌，而hepcidin在調控鐵質上扮演重要角色，會抑制鐵質在腸道的吸收及從儲存細胞的釋放，結果導致功能性鐵質利用不良。補充鐵劑可以改善骨髓對紅血球生成素的反應，用血清ferritin和transferrin saturation來評估體內鐵質會受到發炎狀況的影響，目前國際指引的建議在未透析病人ferritin須維持大於100 ng/ml，血液透析病人須大於200 ng/ml，其他用來評估鐵質較新的檢驗，包括有hemoglobin content of reticulocytes、percentage of hypochromic erythrocytes、erythrocyte zinc protoporphyrin、及soluble transferrin receptor，使用上的準確度及方便性仍有限制。對紅血球生成素治療反應不佳的病人有較差的預後，須個別針對病人找出可改善的因素如angiotensin converting enzyme inhibitor/angiotensin II receptor blocker使用、副甲狀腺亢進、純紅血球再生不良、惡性腫瘤等。治療慢性腎臟病的貧血還有其他正進行臨床試驗中的藥物，如peginesatide直接刺激紅血球生成素的接受器、缺氧誘發因子的穩定劑（hypoxia-inducible factor stabilizer）用來增加紅血球生成素的製造、GATA-2抑制劑或基因治療也都是直接刺激紅血球生成素基因轉譯。
並列摘要
The prevalence of anemia associated with chronic kidney disease (CKD) begins to increase significantly until stage 3 of CKD. Erythropoietin stimulating agents (ESA) in combination with iron are required for optimal management of the anemia currently. ESA hyporesponsiveness remains a marker for adverse outcomes, and iron deficiency is the most common cause. Main factors that contribute to iron deficiency include inadequate dietary iron, blood loss from gastrointestinal tract or during dialysis processes, and impaired iron release from body stores that is unable to meet the demand for erythropoiesis. Chronic inflammation enhances hepcidin production which accounts for the reticuloendothelial cell iron blockade and impaired intestinal iron absorption. Ferritin, an acute phase reactant, measured clinically is influenced by inflammation with CKD. Therefore, serum ferritin level＞100ng/ml is recommended for patients with non-dialysis chronic kidney disease and ＞200ng/ml for dialysis patients. This article reviews the pathogenesis of anemia in CKD, the diagnostic tool of iron homeostasis, the role of hepcidin in regulation of inflammation related anemia, and the newer strategies for correction of anemia.