Cotena S, Piazza O, Tufano R
Department of Anesthesiology and Resuscitation, ''Federico II'' University of Naples, Naples, Italy.
Panminerva Med. 2008 Jun;50(2):185-92.
Global and focal cerebral ischemia is followed by a secondary damage characterized by oxidative stress, excitotoxicity, inflammation and apoptosis. Erythropoietin (EPO) exerts antiapoptotic, anti-inflammatory, antioxidative, angiogenetic and neurotrophic properties. Its potential therapeutic role has been demonstrated in several animal models of cerebral ischemia and also in a clinical trial of ischemic stroke, so it could be considered an ideal compound for neuroprotection in ischemic stroke and in cardiac arrest. Intracerebral hemorrhage (ICH) is the least treatable form of stroke; the mechanisms involved in the secondary brain injury include hematoma mass effect, neuronal apoptosis and necrosis, inflammation. It has been demonstrated in an experimental ICH that EPO intervenes in the inflammatory process, reduces brain water content, hemorrhage volume and hemispheric atrophy, promotes cell survival, preserves cerebral blood flow, has antiapoptotic protective function against oxidative stress and excitotoxic damage. EPO can attenuate acute vasoconstriction and prevent brain ischemic damage in subarachnoid hemorrhage. The neuroprotective function of EPO has been studied also in traumatic brain injury: it reduces the inflammation and improves cognitive and motor deficits. The authors review some of the physiological actions of EPO in the physiopathology of ischemic and hemorrhagic stroke, subarachnoid hemorrhage and brain trauma, and its potential usefulness in the brain injured patient management.
全脑和局灶性脑缺血后会出现以氧化应激、兴奋性毒性、炎症和细胞凋亡为特征的继发性损伤。促红细胞生成素（EPO）具有抗细胞凋亡、抗炎、抗氧化、血管生成和神经营养特性。其潜在的治疗作用已在多种脑缺血动物模型以及一项缺血性中风临床试验中得到证实，因此它可被视为缺血性中风和心脏骤停中神经保护的理想化合物。脑出血（ICH）是最难治疗的中风形式；继发性脑损伤所涉及的机制包括血肿占位效应、神经元凋亡和坏死、炎症。在实验性脑出血中已证实，EPO可干预炎症过程，降低脑含水量、出血量和半球萎缩，促进细胞存活，维持脑血流量，对氧化应激和兴奋性毒性损伤具有抗细胞凋亡保护功能。EPO可减轻急性血管收缩并预防蛛网膜下腔出血中的脑缺血损伤。EPO的神经保护功能也在创伤性脑损伤中得到了研究：它可减轻炎症并改善认知和运动功能障碍。作者综述了EPO在缺血性和出血性中风、蛛网膜下腔出血及脑外伤病理生理学中的一些生理作用，以及其在脑损伤患者管理中的潜在用途。
