Quarello F, Martina G, Beltrame G, Boero R, Forneris G, Borca M, Iadarola G M, Stramignoni E, Maffei S, Piccoli G
Istituto di Nefro-Urologia, Università degli Studi di Torino.
Minerva Urol Nefrol. 1991 Jul-Sep;43(3):125-30.
The aim of the study was to evaluate, before and after hemodialysis (HD), the effects of partial correction of anemia with erythropoietin on: cardiac index (CI), stroke index (SI), heart rate (HR), ventricular ejection index (EVI), mean arterial pressure (PAM) and systemic vascular resistance index (SVRI). Cardiac parameters were gathered by means of transthoracic bioimpedance (BoMed). Twelve patients (6 M, 6 F) aged 50.6 +/- 5 years, on HD for 92.8 +/- 15.9 months, were studied twice (basal, end of follow-up). Before rHuEPO therapy, 6 patients had a "pathologic" cardiac response to HD (defined as an increase of CI despite the reduction of pre-load). After rHuEPO, 5 out of 6 patients with a "pathologic" response reverted to a "normal" response, and 1 hypertensive patient from a "normal" to a "pathologic" response. The EVI, CI and SI of patients with "pathological" response significantly improved after rHuEPO as compared with pre rHuEPO values (EVI 1.36 +/- 0.14 vs 1.07 +/- 0.08, p = 0.023; CI 3.18 +/- 0.24 vs 1.78 +/- 0.27, p less than 0.01; SI 43 +/- 3.7 vs 24 +/- 3.8, p less than 0.01). In conclusion, partial correction of anemia with rHuEPO induces an improvement of myocardial performance, without significant hemodynamic adverse effects. Our results suggest also that anemia could play a significant role in the pathogenesis of myocardial disfunction in HD patients.
本研究的目的是评估在血液透析（HD）前后，使用促红细胞生成素部分纠正贫血对以下指标的影响：心脏指数（CI）、每搏输出指数（SI）、心率（HR）、心室射血指数（EVI）、平均动脉压（PAM）和全身血管阻力指数（SVRI）。心脏参数通过经胸生物阻抗法（BoMed）收集。对12例年龄为50.6±5岁、接受HD治疗92.8±15.9个月的患者（6例男性，6例女性）进行了两次研究（基础值、随访结束时）。在重组人促红细胞生成素（rHuEPO）治疗前，6例患者对HD有“病理性”心脏反应（定义为尽管前负荷降低但CI仍升高）。rHuEPO治疗后，6例有“病理性”反应的患者中有5例恢复为“正常”反应，1例高血压患者从“正常”反应转变为“病理性”反应。与rHuEPO治疗前的值相比，有“病理性”反应的患者在rHuEPO治疗后EVI、CI和SI显著改善（EVI：1.36±0.14 vs 1.07±0.08，p = 0.023；CI：3.18±0.24 vs 1.78±0.27，p＜0.01；SI：43±3.7 vs 24±3.8，p＜0.01）。总之，用rHuEPO部分纠正贫血可改善心肌功能，且无明显的血流动力学不良反应。我们的结果还表明，贫血可能在HD患者心肌功能障碍的发病机制中起重要作用。
