State Pedagogical University, Yaroslavl, Russia.
Clin Hemorheol Microcirc. 2010;44(2):115-23. doi: 10.3233/CH-2010-1259.
The aim of our study was to compare hemorheological consequences of hemotransfusion and recombinant human erythropoetin treatment in anemic cancer patients. Forty anemic patients with solid nonmyeloid malignancies were enrolled in this prospective, open-label study. Both prior to and following treatment (epoetin beta, 10,000 units subcutaneously thrice weekly, for four weeks and transfusion of 400 ml of erythrocyte mass) hemorheological measurements including blood and plasma viscosity, hematocrit (Hct), hemoglobin, red blood cell aggregation (RBCA) and deformability were completed. It was found an increase of Hb from 76.07+/-3.68 g/l to 87.86+/-4.26 g/l after the transfusion. It was accompanied by Hct rise by 25% (from 23.67+/-1.85 to 29.50+/-1.96%, p<0.05). Under these conditions the whole blood viscosity (BV) was increased by 19% (p<0.05). Plasma viscosity did not change markedly. Therefore the main cause of the whole blood viscosity rise was an increase of Hct. After erythrocyte mass transfusion there were some increases of red cell deformability and aggregation (by 7%, p>0.05). Under these conditions the Hct/BV ratio as an index of oxygen transport efficiency was changed after transfusion only slightly. While after four weeks of epoetin treatment the hematocrit/viscosity ratio was raised by 14% (p<0.05), in spite of the high blood viscosity. In addition RBCA decreased (p<0.01) and their deformability was increased by 14% (p<0.05). In vitro microrheological data permit to suggest that epoetin has a direct effect on the microrheological properties of red cells due to activation of the cellular signal transduction system including the tyrosine kinases and phosphatases. Thus, Epoetin beta administered s.c. thrice weekly, during four weeks, increased hemoglobin levels, improved hemorheological profile and especially its microrheological part as well as the blood transport capacity in anemic cancer patients who were receiving chemotherapy and its hemorheological effect was more positive than under hemotransfusion.
我们研究的目的是比较输血和重组人红细胞生成素治疗贫血癌症患者的血液流变学后果。40 例患有实体非髓性恶性肿瘤的贫血患者参加了这项前瞻性、开放性研究。在治疗（每周皮下注射 10000 单位的促红细胞生成素β，共四周，以及输注 400ml 红细胞）前后，完成了血液和血浆粘度、红细胞压积（Hct）、血红蛋白、红细胞聚集（RBCA）和变形性等血液流变学测量。发现输血后血红蛋白从 76.07+/-3.68g/l 增加到 87.86+/-4.26g/l。同时，Hct 增加了 25%（从 23.67+/-1.85 到 29.50+/-1.96%，p<0.05）。在这些条件下，全血粘度（BV）增加了 19%（p<0.05）。血浆粘度没有明显变化。因此，全血粘度升高的主要原因是 Hct 的增加。输血后，红细胞变形性和聚集性略有增加（增加 7%，p>0.05）。在这些条件下，Hct/BV 比值作为氧输送效率的指标仅在输血后略有改变。而在接受促红细胞生成素治疗四周后，红细胞压积/粘度比值升高 14%（p<0.05），尽管血液粘度较高。此外，RBCA 降低（p<0.01），变形性增加 14%（p<0.05）。体外微流变学数据表明，促红细胞生成素通过激活包括酪氨酸激酶和磷酸酶在内的细胞信号转导系统对红细胞的微流变特性有直接影响。因此，每周皮下注射三次促红细胞生成素β，四周后，增加血红蛋白水平，改善血液流变学特征，特别是其微流变学部分以及贫血癌症患者的血液输送能力，这些患者正在接受化疗，其血液流变学效应比输血更为积极。
