Division of Pain Medicine, Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30322, USA.
Atlanta Veterans Affairs Healthcare System, Decatur, GA, 30033, USA.
Neurochem Res. 2021 Apr;46(4):732-739. doi: 10.1007/s11064-021-03242-z. Epub 2021 Feb 1.
Erythropoietin (EPO) is an exciting neurotherapeutic option. Despite its potential, concerns exist regarding the potential for thrombosis and adverse events with EPO administration in normonemic adults. Systematic review of literature using PRISMA guidelines to examine the application and risks of EPO as a treatment option for neuroprotection in normonemic adults. Independent, systematic searches were performed in July 2019. PubMed (1960-2019) and the Cochrane Controlled Trials Register (1960-2019) were screened. Search terms included erythropoietin, neuroprotection, and humans. The PubMed search resulted in the following search strategy: ("erythropoietin" [MeSH Terms] OR "erythropoietin" [All Fields] OR "epoetin alfa" [MeSH Terms] OR ("epoetin" [All Fields] AND "alfa" [All Fields]) OR "epoetin alfa" [All Fields]) AND ("neuroprotection" [MeSH Terms] OR "neuroprotection" [All Fields]) AND "humans" [MeSH Terms]. PubMed, Cochrane Controlled Trials Register, and articles based on prior searches yielded 388 citations. 50 studies were included, comprising of 4351 patients. There were 13 studies that noted adverse effects from EPO. Three attributed serious adverse effects to EPO and complications were statistically significant. Two of these studies related the adverse events to the co-administration of EPO with tPA. Minor adverse effects associated with the EPO group included nausea, pyrexia, headache, generalized weakness and superficial phlebitis. Most published studies focus on spinal cord injury, peri-surgical outcomes and central effects of EPO. We found no studies to date evaluating the role of EPO in post-operative pain. Future trials could evaluate this application in persistent post-surgical pain and in the peri-operative period.
促红细胞生成素（EPO）是一种令人兴奋的神经治疗选择。尽管有潜力，但在正常血压成年人中使用 EPO 治疗存在血栓形成和不良反应的担忧。使用 PRISMA 指南系统地审查文献，以检查 EPO 作为正常血压成年人神经保护治疗选择的应用和风险。2019 年 7 月进行了独立的系统搜索。筛选了 PubMed（1960-2019 年）和 Cochrane 对照试验登记处（1960-2019 年）。搜索词包括促红细胞生成素、神经保护和人类。PubMed 搜索采用了以下搜索策略：（“erythropoietin”[MeSH 术语]或“erythropoietin”[所有字段]或“epoetin alfa”[MeSH 术语]或（“epoetin”[所有字段]和“alfa”[所有字段]）或“epoetin alfa”[所有字段]）和“neuroprotection”[MeSH 术语]或“neuroprotection”[所有字段]）和“humans”[MeSH 术语]。基于之前的搜索，PubMed、Cochrane 对照试验登记处和文章共产生了 388 条引文。纳入了 50 项研究，共包括 4351 例患者。有 13 项研究指出了 EPO 的不良反应。其中 13 项研究将 EPO 的不良反应归因于与 tPA 联合应用的严重不良反应，并发症具有统计学意义。其中两项研究将不良反应与 EPO 与 tPA 联合应用相关联。EPO 组相关的轻微不良反应包括恶心、发热、头痛、全身无力和浅表静脉炎。大多数已发表的研究都集中在脊髓损伤、围手术期结果和 EPO 的中枢作用上。我们没有发现迄今为止评估 EPO 在术后疼痛中作用的研究。未来的试验可以评估 EPO 在持续性术后疼痛和围手术期的应用。
