老年人肾功能、贫血和促红细胞生成素的相关性
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Renal function, anemia and erythropoietin in the elderly
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    目的 通过分析老年人肾小球滤过率(GFR)和血清促红细胞生成素(EPO)水平对老年贫血患病率的影响, 探讨老年贫血发生的相关因素及其与老年人肾功能水平的关系。方法 选取200例年龄≥60岁的老年患者作为观察对象, 既往无慢性疾病的健康体检者30人作为正常对照组。采用Cockcroft-Gault方程计算eGFR; 根据eGFR分为A组[eGFR>50 ml/(min?1.73m2), 62例]、B组[30 ml/(min?1.73m2)≤eGFR≤50 ml/(min?1.73m2), 114例]和C组[eGFR<30 ml/(min?1.73m2), 24例]; 66例老年贫血患者再根据GFR估算值(eGFR)分为AA组、AB组和AC组(分组标准同上)。测定血红蛋白(Hb)、血肌酐(Scr)、EPO水平。结果 伴随着肾功能水平的降低, 老年人贫血患病率呈升高趋势, 并且A, B, C 3组之间比较均有显著性差异(P<0.05); 正常对照组Log EPO与Hb呈负相关(r2 = 0.219, P = 0.009); A组Log EPO与Hb成负相关(r2 = 0.065, P = 0.045), B组Log EPO与Hb之间无相关关系, C组Log EPO与Hb为正相关(r2 = 0.294, P = 0.006); 老年贫血患者随着肾功能水平的降低, EPO呈现下降趋势, AA组和AC组比较有显著性差异(P = 0.042)。结论 老年人肾功能水平中度减退时贫血患病率即显著增加; 随着年龄的增长, 老年人EPO的分泌代偿性增加, 但随着eGFR的不断下降, 这种代偿机制逐渐减弱; 当肾功能水平严重降低时, EPO分泌的减少是老年贫血发生的主要原因。

    Abstract:

    Objective To explore the correlative factors for anemia and the correlation of kidney function with anemia in the elderly through investigating the influence of glomerular filtration rate(GFR) and erythropoietin(EPO) on anemia incidence. Methods A total of 200 elderly patients(≥60 years) were enrolled and divided into three groups according to estimated GFR(eGFR) with Cockcroft-Gault equation: group A(62 cases), eGFR>50 ml/(min?1.73m2); group B(114 cases), 30 ml/(min?1.73m2)≤eGFR≤50 ml/(min?1.73m2); group C(24 cases), eGFR<30 ml/(min?1.73m2). Besides, 30 healthy adults were selected as control group. In addition, 66 elderly patients with anemia were divided into group AA, AB and AC according to eGFR (the same as above standard). Hemoglobin(Hb), serum creatinine(Scr) and serum EPO were measured. Results Anemia incidence of the elderly increased with decline of renal function(P<0.05). Log EPO was negatively correlated with Hb in control group(r2 = 0.219, P = 0.009) and group A(r2 = 0.065, P = 0.045), but positively correlated with Hb in group C(r2 = 0.294, P = 0.006). There was no correlation between LogEPO and Hb in group B. In the elderly with anemia, EPO level decreased with decline of renal function. Compared with group AA, LogEPO was significantly reduced in group AC(P = 0.042). Conclusion In the elderly with moderate decline of renal function, prevalence of anemia increases significantly. EPO shows compensatory increase with age, which is weakened with decrease of eGFR, and low EPO may be a main reason for anemia in the elderly with severe reduced renal function.

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杨华昱, 顾 乡, 陈海平.老年人肾功能、贫血和促红细胞生成素的相关性[J].中华老年多器官疾病杂志,2012,11(1):30~34

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