Hemodynamics, Autonomic Functions, and Platelet Cytosolic Calcium Following Erythropoietin Treatment of Hemodialysis Patients

紅血球生成素治療對血液透析患者的血液動力學、自主神經系統作用、及血小板胞液鈣的影響

陳秋安(Chiou-An Chen) ； 吳家兆(Chia-Chao Wu) ； 吳三江(San-Chiang Wu) ； 余福九(Fu-Chiu Yu) ； 林石化(Shih-Hua Lin) ； 戴良恭(Liang-Kuang Diang) ； 朱柏齡(Pau-Ling Chu) ； 林裕峰(Yuh-Feng Lin)

《Acta Nephrologica》 20卷2期 (2006/04) Pp. 109-115

摘要

背景：雖然合成基因人類紅血球生成素對於尿毒症貧血是主要的治療方式，但是其對於血液透析患者的全身性作用尚未完全了解。
方法：合成基因人類紅血球生成素的初始劑量是每次25-50單位／公斤，每週施打三次，劑量隨著透析前血色素濃度作調整，每三個月調整一次，將血色素控制在11-12克／100毫升。
結果：合成基因人類紅血球生成素治療後有意義地增加平均動脈壓、血比容、和總周邊血管阻力，及降低心臟輸出量。血液中正腎上腺素、腎上腺素、度巴胺和血小板胞液鈣濃度也有意義地上升，自主神經系統作用也獲得改善。平均動脈壓和總周邊血管阻力、體位性收縮壓、正腎上腺素、及血小板胞液鈣濃度成正相關。
結論：合成基因人類紅血球生成素矯正血液透析患者的貧血症及改善其血液動力學和自主神經系統作用。而且總周邊血管阻力、血液中鄰苯二醇胺及血小板胞液鈣濃度的增加都和合成基因人類紅血球生成素治療後造成的血壓上升有關。

關鍵字

紅血球生成素 ； 血液動力學 ； 自主神經系統作用 ； 血小板胞液鈣 ； 鄰苯二醇胺

並列摘要

Background: Although recombinant human erythropoietin (rh-EPO) is a major therapeutic advance in the treatment of uremic anemia, its systemic effects in hemodialysis (HD) patients have not been well documented.
Methods: Twelve HD patients with anemia (6 men and 6 women) were investigated. The initial dose of rh-EPO was 25-50 μ/kg intravenously three times a week. The dose was then adjusted to maintain the predialytic hemoglobin concentration in the range of 11-12 g/dL for 3 months. Measurements were conducted before and after rh-EPO treatment.
Results: rh-EPO treatment significantly increased mean arterial pressure, hematocrit, and total peripheral vascular resistance, and decreased cardiac output. Plasma concentrations of norepinephrine, epinephrine, dopamine, and platelet cytosolic calcium concentrations were also significantly elevated by rh-EPO therapy. Autonomic function was improved by rh-EPO therapy. Mean arterial pressure was positively correlated with total peripheral resistance, orthostasis systolic pressure, norepinephrine, and platelet cytosolic calcium concentration.
Conclusions: Erythropoietin corrected anemia, augmented hemodynamics, and improved autonomic functions in HD patients. Increased total peripheral vascular resistance, augmented plasma catecholamine levels, and increased intracellular calcium concentrations all contributing to the elevation in blood pressure following rh-EPO therapy. The effects of long-term use of rh-EPO require further study.

並列關鍵字

erythropoietin ； platelet cytosolic calcium ； catecholamines ； hemodynamics ； autonomic function