慢性病性贫血

• How do erythropoiesis-stimulating agents affect outcomes in people with cancer?
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• In adults with chemotherapy-induced anemia, how does adding iron supplementation to erythropoiesis-stimulating agents (ESAs) compare with ESAs alone?
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• What are the effects of erythropoiesis-stimulating agents for anemia in adults with chronic kidney disease?
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证据评分

证据 A 死亡率和 Hb 阈值：有来自随机对照试验和系统评价的高质量证据表明，Hb 升高至＞120 g/L (＞12 g/dL) 时，死亡率升高。[36]Rizzo JD, Brouwers M, Hurley P, et al. American Society of Clinical Oncology/American Society of Hematology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer. J Oncol Pract. 2010 Nov;6(6):317-20.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988667/http://www.ncbi.nlm.nih.gov/pubmed/21358963?tool=bestpractice.com[51]Jelkmann W. Developments in the therapeutic use of erythropoiesis stimulating agents. Br J Haematol. 2008 May;141(3):287-97.http://www.ncbi.nlm.nih.gov/pubmed/18410567?tool=bestpractice.com[52]Singh AK, Szczech L, Tang KL, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006 Nov 16;355(20):2085-98.https://www.nejm.org/doi/10.1056/NEJMoa065485http://www.ncbi.nlm.nih.gov/pubmed/17108343?tool=bestpractice.com[53]Blau CA. Erythropoietin in cancer: presumption of innocence? Stem Cells. 2007 Aug;25(8):2094-7.https://stemcellsjournals.onlinelibrary.wiley.com/doi/epdf/10.1634/stemcells.2007-0229http://www.ncbi.nlm.nih.gov/pubmed/17464082?tool=bestpractice.com[54]Schrijvers D, De Samblanx H, Roila F; ESMO Guidelines Working Group. Erythropoiesis-stimulating agents in the treatment of anaemia in cancer patients: ESMO clinical practice guidelines for use. Ann Oncol. 2010 May;21(suppl 5):v244-7.http://annonc.oxfordjournals.org/content/21/suppl_5/v244.longhttp://www.ncbi.nlm.nih.gov/pubmed/20555090?tool=bestpractice.com 建议每周监测 Hb，如果 Hb 迅速升高或接近 120 g/L (12 g/dL) 时，则应调整剂量或暂停治疗。Hb 稳定后应每月进行一次检查。 系统评价或者受试者＞200名的随机对照临床试验（RCT）。

死亡率和 Hb 阈值：有来自随机对照试验和系统评价的高质量证据表明，Hb 升高至＞120 g/L (＞12 g/dL) 时，死亡率升高。[36]Rizzo JD, Brouwers M, Hurley P, et al. American Society of Clinical Oncology/American Society of Hematology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer. J Oncol Pract. 2010 Nov;6(6):317-20.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988667/http://www.ncbi.nlm.nih.gov/pubmed/21358963?tool=bestpractice.com[51]Jelkmann W. Developments in the therapeutic use of erythropoiesis stimulating agents. Br J Haematol. 2008 May;141(3):287-97.http://www.ncbi.nlm.nih.gov/pubmed/18410567?tool=bestpractice.com[52]Singh AK, Szczech L, Tang KL, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006 Nov 16;355(20):2085-98.https://www.nejm.org/doi/10.1056/NEJMoa065485http://www.ncbi.nlm.nih.gov/pubmed/17108343?tool=bestpractice.com[53]Blau CA. Erythropoietin in cancer: presumption of innocence? Stem Cells. 2007 Aug;25(8):2094-7.https://stemcellsjournals.onlinelibrary.wiley.com/doi/epdf/10.1634/stemcells.2007-0229http://www.ncbi.nlm.nih.gov/pubmed/17464082?tool=bestpractice.com[54]Schrijvers D, De Samblanx H, Roila F; ESMO Guidelines Working Group. Erythropoiesis-stimulating agents in the treatment of anaemia in cancer patients: ESMO clinical practice guidelines for use. Ann Oncol. 2010 May;21(suppl 5):v244-7.http://annonc.oxfordjournals.org/content/21/suppl_5/v244.longhttp://www.ncbi.nlm.nih.gov/pubmed/20555090?tool=bestpractice.com 建议每周监测 Hb，如果 Hb 迅速升高或接近 120 g/L (12 g/dL) 时，则应调整剂量或暂停治疗。Hb 稳定后应每月进行一次检查。