在有急性肾损伤风险的危重症患者中使用促红细胞生成素的生理基础。
Physiological basis for the use of erythropoietin in critically ill patients at risk for acute kidney injury.
作者信息
Bernhardt Wanja M, Eckardt Kai-Uwe
机构信息
Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
出版信息
Curr Opin Crit Care. 2008 Dec;14(6):621-6. doi: 10.1097/MCC.0b013e328317ee82.
PURPOSE OF REVIEW
Acute kidney injury (AKI) frequently occurs in critically ill patients and is an independent risk factor for poor outcome. The prevention of kidney injury in intensive care remains a great challenge as specific nephroprotective therapies are still lacking. The present review summarizes recent evidence for the use of erythropoietin as a promising candidate to provide protection from AKI.
RECENT FINDINGS
Beyond the known hematopoietic actions of erythropoietin, a number of preclinical studies demonstrated that erythropoietin possesses pleiotropic, organ-protecting properties. Preconditional and postconditional erythropoietin treatment was shown to protect from ischemic, toxic and septic AKI. Despite heterogeneities in study design and dose, erythropoietin consistently ameliorated renal injury. The mechanisms of protection remain largely unclear but may involve reduction of apoptosis, induction of cellular proliferation and tissue repair as well as mobilization of stem cells.
SUMMARY
Animal studies revealed a physiological basis for the use of erythropoietin in AKI, which may be clinically applicable to prevent AKI in critically ill patients, but clinical studies are still lacking.
综述目的
急性肾损伤(AKI)在重症患者中频繁发生,是预后不良的独立危险因素。由于仍缺乏特异性肾保护疗法,重症监护中预防肾损伤仍是一项巨大挑战。本综述总结了近期有关使用促红细胞生成素作为预防AKI的有前景候选药物的证据。
最新发现
除了已知的促红细胞生成素的造血作用外,多项临床前研究表明促红细胞生成素具有多效性的器官保护特性。促红细胞生成素的预处理和后处理均显示可预防缺血性、中毒性和脓毒症性AKI。尽管研究设计和剂量存在异质性,但促红细胞生成素始终能改善肾损伤。保护机制仍 largely 不清楚,但可能涉及减少细胞凋亡、诱导细胞增殖和组织修复以及动员干细胞。
总结
动物研究揭示了在AKI中使用促红细胞生成素的生理基础,这在临床上可能适用于预防重症患者的AKI,但仍缺乏临床研究。