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Treatment of Chronic Kidney Disease Guided by Evidence-Based Medicine

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.

老年钩虫感染致贫血的临床分析

【摘要】　目的　总结老年钩虫感染致贫血的临床特点和治疗方法。　方法　2004年9月—2010年12月，收治老年钩虫感染致贫血37例。其中男23例，女14例；年龄60~81岁，平均71岁；病程3周~2年。以头昏、乏力及上腹部不适、隐痛等消化道症状为主要临床表现。大便常规查见钩虫卵31例，胃镜于十二指肠球部及降段发现钩虫吸附于肠壁黏膜而诊断26例。给予左旋咪唑或甲苯达唑顿服驱虫治疗，连用3 d。　结果　经治疗，患者临床症状及贫血迅速改善。随访3~6个月，所有患者血红蛋白均升至110 g/L以上。　结论　钩虫感染是导致老年人贫血的原因之一，反复在大便中查找钩虫卵及胃镜检查是诊断钩虫病的重要方法。

异位胸腺瘤合并单纯红细胞再生障碍性贫血一例

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。

慢性阻塞性肺疾病患者贫血原因探讨

目的 探讨稳定期COPD 患者贫血的原因。方法 选择稳定期COPD 患者60 例, 测定其Hb、C 反应蛋白( CRP) 、促红细胞生成素( EPO) 、肺功能、身高和体重, 计算体重指数( BMI) 。根据Hb 浓度分为贫血组和非贫血组, 比较两组CRP、EPO、肺功能损害程度、BMI 的差异。结果 贫血组8例, 非贫血组52 例, 贫血发生率为13. 3% 。贫血组CRP 和EPO 水平显著高于非贫血组[ ( 20. 46 ±9. 43) mg/L比( 13. 75 ±2. 14) mg/L, ( 28. 7 ±5. 2) U/L 比( 14. 7 ±4. 5) U/L, P 均lt;0. 05] , 肺功能和BMI 在两组之间无显著差异( P gt;0. 05) 。贫血组的EPO 与CRP 水平呈明显负相关( r = - 0. 918, P lt;0. 01) , 这种相关性在非贫血组中不存在( P gt; 0. 2) 。结论 COPD 患者发生贫血可能与慢性炎症及EPO 抵抗有关。

Analysis of the incidence and influencing factors of anemia in patients with colorectal cancer

ObjectiveTo investigate the incidence of perioperative anemia and the influencing factors of preoperative anemia in patients with colorectal cancer.MethodsThe clinicopathological data of 1 250 patients with colorectal cancer who underwent surgery in our hospital from January 1, 2019 to December 31, 2019 were analyzed retrospectively. According to the preoperative hemoglobin level, patients were divided into anemia group and non-anemia group. Univariate analysis and multivariate logistic regression analysis were used to explore the influencing factors of preoperative anemia in patients with colorectal cancer, and the effects of preoperative anemia on intraoperative blood transfusion, postoperative complications, and postoperative hospital stay were analyzed.ResultsThe incidence of preoperative anemia in patients with colorectal cancer was 40.6% (508/1 250), and the incidence of preoperative anemia in patients with right colon cancer, left colon cancer, and rectal cancer was 66.0% (192/291), 41.1% (139/338), and 28.5% (177/621), respectively. The incidence of postoperative anemia in patients with colorectal cancer was 69.4% (867/1 250), and the incidence of postoperative anemia in patients with right colon cancer, left colon cancer, and rectal cancer was 81.8% (238/291), 68.9% (233/338), and 63.8% (396/621), respectively. Multivariate logistic regression analysis showed that age >60 years old, nutritional risk screening 2002 ≥3, right colon cancer, T3–4 stage, and M1 stage were risk factors for preoperative anemia in patients with colorectal cancer (P<0.05). The rate of intraoperative blood transfusion and the incidence of postoperative complications in the preoperative anemia group of patients with colorectal cancer were higher than those in the non-anemia group (P<0.05). The postoperative hospital stay in the preoperative anemia group of patients with colon cancer was longer than that in the non-anemia group (P<0.05).ConclusionsThe incidence of perioperative anemia in patients with colorectal cancer is high. Advanced age, high nutritional risk, right colon cancer, T3–4 stage, and distant metastasis were the risk factors of preoperative anemia in patients with colorectal cancer. Preoperative anemia can increase the demand for intraoperative blood transfusion and the incidence of postoperative complications in patients with colorectal cancer, and prolong postoperative hospital stay of colon cancer patients.

Pharmacoeconomics of ferric carboxymaltose in patients with iron deficiency anemia: a systematic review

ObjectiveTo systematically review the pharmacoeconomics of high-dose intravenous iron ferric carboxymaltose in the treatment of patients with iron deficiency anemia. MethodsPharmacoeconomic studies of ferric carboxymaltose in the treatment of patients with iron deficiency anemia were searched in PubMed, The Cochrane Library, York University CRD, Web of Science, EBSCO, CNKI, WanFang Data and VIP databases, and relevant health technology assessment websites from inception to September 30th, 2021. A descriptive analysis was performed after two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. ResultsA total of 11 studies were included, most of them compared the health economics of ferric carboxymaltose with other therapies from a hospital perspective. The main costs included in these studies were costs for iron, infusion, blood transfusion, EPO, hospitalization, and transportation, as well as productivity cost. The ferric carboxymaltose was presumed to be more economical than other intravenous irons. ConclusionIt is suggested that the ferric carboxymaltose be considered in more clinical settings to improve the ischemic condition of patients with iron deficiency anemia, so as to promote the rational utilization of medical resources.

The Value of BIO-RAD D-10 Hemoglobin Testing System

目的：评价BIO-RAD D-10血红蛋白(Hb)检测仪在地中海贫血筛查中的应用。方法:对BIO-RAD D-10血红蛋白检测仪进行性能评价，并测定我院门诊及住院病人HbA2及HbF含量，同时采用法国Sebia全自动电泳仪进行血红蛋白琼脂糖电泳，比较两种方法对HbA2及HbF含量的检测结果。结果：BIORAＤ D-10血红蛋白检测仪检测HbA2及HbF批内精密度为4.8％、2.77％和1.42％、1.7％，批间精密度为491％、3.97％和2.87％、2.3％。共检测了1026例临床标本，并通过全自动琼脂糖凝胶电泳进行定量扫描，得出BIO-RAD D-10测定灵敏度为HbF 88.3％、HbA297.７％，特异性为HbF 96.7％、HbA2为95.6％,阳性预测值为HbF 97.4％、HbA2 96.9％,阴性预测值为HbF 85.4％、HbA2 96.6％。但如果有其他异常血红蛋白条带或血红蛋白H、Bart’s,D-10血红蛋白检测仪不能识别，只能分辨出未知峰。结论：BIO-RAD D-10血红蛋白检测仪能够分辨出HbA2及HbF异常增高者，为β地中海贫血的初筛提供快速的诊断依据。

High risk factors of iron deficiency in children with congenital heart disease

Objective To investigate the iron deficiency (ID) in children with congenital heart disease (CHD) and find high risk factors of ID. Methods The clinical data of 227 pediatric patients with CHD from February to June 2016 were retrospectively analyzed. The incidence of ID according to the result of iron metabolism examination (serum ferritin <12 μg/L as the diagnostic criteria) was investigated. According to their basic CHD types, patients were divided into a cyanotic group and an acyanotic group. We tried to find the high risk factors of ID in those pediatric CHD patients by comparing their age, gender, growth condition and blood routine test results. Results There were 19.8% pediatric CHD patients complicated by ID. The incidence of ID in the cyanotic patients was higher than that in the acyanotic patients (31.0% vs. 17.3%, P=0.045). In both groups, ID patients presented the characteristics of younger age, higher anemia rate, lower mean corpuscular volume (MCV), lower mean corpuscular hemoglobin (MCH), lower mean corpuscular-hemoglobin concentration (MCHC) and longer red blood cell distribution width (RDW). Conclusion Cyanosis, younger age (infant), anemia, decreased MCV, decreased MCH, decreased MCHC and increased RDW are high risk factors of ID in CHD children.

The Administration of Highdose Recombinant Human Erythropoietin in Multiple Myeloma Patients with Anemia

目的:多发性骨髓瘤(Multiple Myeloma,MM)患者约有80%伴有贫血,临床上多数患者以输血方式纠正贫血。重组人促红细胞生成素(recombinant human erythropoietin, rHuEPO)用于治疗MM患者的贫血尽管有效,但以何等剂量、应用多长时间疗效较佳尚无定论。目的: 观察持续使用大剂量rHuEPO对MM患者贫血的纠正作用及效果。方法:87例诊断明确的多发性骨髓瘤伴有贫血的患者,开始连续每天使用重组人促红细胞生成素4万单位,皮下注射,共5d;以后每周使用一次,每次4万单位皮下注射,间断补充铁剂。对照组90例选自同期住院的诊断明确的多发性骨髓瘤患者,当其贫血症状明显时或血红蛋白水平低于60 g/L时,给予输血纠正其贫血,使多数患者血红蛋白水平维持在80 g/L～100 g/L以上。两组患者化疗方案不做特殊规定,整过研究观察期6月。结果: rHuEPO组在使用rHuEPO后2周其血红蛋白开始上升,中位反应时间16d;1月半至2月血红蛋白可升至正常水平,达正常血红蛋白水平的中位时间51d。进入研究后3月和6月时,rHuEPO组生活幸福感指数(INLH)明显优于输血组,分别为6927±318(Plt;005)和7216±283(Plt;001)与5835±289和5776±324。6月后,rHuEPO组平均每例直接费用成本1075440元,明显低于输血组需要达到同样效果所需的每例2070420元。结论:大剂量rHuEPO治疗MM相关性贫血优于输血,其起效快、疗效好,患者生活幸福感改善明显,费用成本低,安全性较好。