Di Paolo B, Di Liberato L, Fiederling B, Catucci G, Bucciarelli S, Paolantonio L, Albertazzi A
Department of Nephrology, University of Chieti, Italy.
ASAIO J. 1992 Jul-Sep;38(3):M477-80. doi: 10.1097/00002480-199207000-00080.
Quantitative electrophysiologic assessments are sensitive and useful indices of clinical state, and they are valuable in evaluating brain electrical activity before and after recombinant human erythropoietin (r-HuEPO) treatment. To study the hypothesis that, theoretically, anemia might be a cause of brain dysfunction in uremia, the authors assessed 18 patients (10 men and 8 women) on hemodialysis (RDT, age range, 35-58 years) before treatment (T1), and after 12 weeks (T2) and 24 weeks (T3) of r-HuEPO treatment, utilizing the following electrophysiologic tests: visual evoked potentials (VEP), brainstem auditory evoked responses (BAER), and somatosensory evoked potentials (SEP). The r-HuEPO was injected subcutaneously two times a week after RDT to produce hematocrit (Hct) levels of 30-35%. This drug induced a decrement of latency in P100 VEP (134.2 +/- 7.9 msec in T1 versus 116.5 +/- 6.9 msec in T2, p < 0.001, and versus 107.6 +/- 5.7 msec in T3, p < 0.005) and in the four main components of BAER. The most significant SEP changes were P27-N35 from peroneal nerve (p < 0.01), as an augmentation of SEP amplitude. Correction of anemia with r-HuEPO leads to a significant improvement in brain function in patients on RDT. The increased Hct level leads to enhanced brain oxygen delivery, directly improving brain metabolism. When the Hct rises, cerebral blood flow falls from high levels to normal, decreasing delivery of uremic "toxins" to the brain. The decrease in cerebral blood flow may decrease intracranial pressure and, in this way, may exert its beneficial effects by a rheologic pathway.
定量电生理评估是临床状态敏感且有用的指标，在评估重组人促红细胞生成素（r-HuEPO）治疗前后的脑电活动方面具有重要价值。为了研究理论上贫血可能是尿毒症患者脑功能障碍原因这一假设，作者对18例接受血液透析的患者（10例男性和8例女性，RDT，年龄范围35 - 58岁）在治疗前（T1）、r-HuEPO治疗12周后（T2）和24周后（T3）进行了评估，采用以下电生理测试：视觉诱发电位（VEP）、脑干听觉诱发电位（BAER）和体感诱发电位（SEP）。r-HuEPO在血液透析后每周皮下注射两次，以使血细胞比容（Hct）水平达到30% - 35%。该药物导致P100 VEP潜伏期缩短（T1时为134.2±7.9毫秒，T2时为116.5±6.9毫秒，p<0.001，T3时为107.6±5.7毫秒，p<0.005）以及BAER四个主要成分的潜伏期缩短。SEP最显著的变化是腓总神经的P27 - N35（p<0.01），表现为SEP波幅增大。用r-HuEPO纠正贫血可使接受血液透析的患者脑功能显著改善。Hct水平升高导致脑氧输送增加，直接改善脑代谢。当Hct升高时，脑血流量从高水平降至正常，减少尿毒症“毒素”向脑内的输送。脑血流量的减少可能会降低颅内压，从而通过血液流变学途径发挥其有益作用。
