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促红细胞生成素的皮下给药

Authors
Wajeh Y Qunibi, MD
William L Henrich, MD, MACP
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD
Translators
生杰, 主任医师，副教授

引言

虽然促红细胞生成素(erythropoietin, EPO)通常经静脉途径用于维持性血液透析患者，但经皮下途径用于血液透析、腹膜透析和濒临透析前的患者也有一些优点。包括半衰期更长；血浆EPO浓度更稳定持久，有利于减少EPO的剂量；以及发生EPO诱导性高血压的风险可能较低。从实际情况考虑，对于还没有进行血液透析的慢性肾脏病(chronic kidney disease, CKD)患者，皮下给予EPO可让患者自行给药，而不需要就诊(除非因为保险需要到门诊)和静脉通路。然而，皮下应用EPO的不良反应通常与静脉给药相似。

一些患者主诉注射部位疼痛，这可能是作为稳定剂的枸橼酸盐引起的，使用浓缩制剂可尽量减轻这种疼痛。

纯红细胞再生障碍性贫血的发生主要与皮下应用特定的EPO制剂Eprex有关，Eprex这种产品在美国之外的地区生产和销售。还有报道称，使用其他制剂时该疾病的发生率较低。该制剂的生产商根据一些分析结果，制定了一个“最佳操作实践”程序，同时改变了药品说明书中的相关内容，即对CKD患者禁用皮下给药的Eprex。EPO相关纯红细胞再生障碍性贫血目前非常罕见。 (参见“抗红细胞生成素抗体所致的纯红细胞再生障碍性贫血”)

以下是CKD患者经皮下途径使用EPO的简要概述。该患者群使用EPO的详细讨论，参见其他专题。 (参见“非透析慢性肾脏病患者贫血的治疗”和“血液透析患者慢性肾脏病性贫血的促红细胞生成素治疗”)

红细胞生成刺激剂(erythropoietin-stimulating agent, ESA，包括EPO)的不良反应将在别处讨论。 (参见“慢性肾脏病贫血：使用促红细胞生成药物治疗的患者的目标血红蛋白/血细胞比容”，关于‘不良反应’一节和“血液透析患者慢性肾脏病性贫血的促红细胞生成素治疗”，关于‘高血红蛋白水平相关的心血管不良效应’一节和“非透析慢性肾脏病患者贫血的治疗”，关于‘不良反应’一节)

         

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-23.
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