Spivak J L
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2196.
Semin Hematol. 1993 Oct;30(4 Suppl 6):2-11.
From the foregoing data, it is clear that erythropoietin production is tightly regulated not only under normal circumstances but also during hypoxia, unless the hypoxia is extreme. Various disease states can have a negative impact on erythropoietin production, but while altering it quantitatively, they do not appear to abrogate basic fundamental control mechanisms. Rather, the threshold stimulus for either the recruitment of cells to produce erythropoietin or the effective production of erythropoietin is altered, usually in a predictable fashion. However, a reduction in erythropoietin production inevitably leads to a reduction in erythropoiesis. Nevertheless, assuming that the bone marrow remains responsive, administration of exogenous erythropoietin will increase the red blood cell mass. The immunoassay for serum erythropoietin therefore provides a means for identifying those situations in which erythropoietin therapy should be effective, but the assay must be used critically, bearing in mind the physiology of the hormone and the threshold concept of erythropoietin production (Table 3).
从上述数据可以清楚地看出，促红细胞生成素的产生不仅在正常情况下受到严格调节，而且在缺氧状态下也是如此，除非缺氧极其严重。各种疾病状态可能会对促红细胞生成素的产生产生负面影响，但在定量改变它的同时，似乎并未废除基本的控制机制。相反，促使细胞产生促红细胞生成素或有效产生促红细胞生成素的阈值刺激通常以可预测的方式发生改变。然而，促红细胞生成素产生的减少不可避免地导致红细胞生成的减少。尽管如此，假设骨髓仍然有反应，给予外源性促红细胞生成素将增加红细胞量。因此，血清促红细胞生成素的免疫测定为确定促红细胞生成素治疗应有效的那些情况提供了一种手段，但在使用该测定时必须谨慎，要牢记该激素的生理学特性以及促红细胞生成素产生的阈值概念（表3）。
