Lewis N P, Macdougall I C, Willis N, Coles G A, Williams J D, Henderson A H
Department of Cardiology, University of Wales College of Medicine, Cardiff, UK.
Eur J Clin Invest. 1993 Jul;23(7):423-7. doi: 10.1111/j.1365-2362.1993.tb00785.x.
The effects of treating the anaemia of end-stage renal failure with erythropoietin were studied in nine dialysis patients. The increase in haemoglobin concentration (by 59% from 7.0 +/- 1.2 to 11.1 +/- 1.1 g dl-1) was associated with increases in exercise duration (by 41%) and maximum oxygen consumption (by 34%). Treatment reduced resting heart rate but did not significantly alter heart rate at maximum exercise, nor resting or exercise blood pressure. Resting arterial potassium concentrations were slightly increased after treatment, but they increased similarly in relation to minute ventilation during exercise. Lactic acidaemia developed during exercise at both levels of haemoglobin, and was accompanied by similar reductions in arterial pH and bicarbonate levels but constant PaO2 and PaCO2. Ventilation was coupled to the metabolic rate of carbon dioxide production, ventilatory dead-space and arterial PCO2 before and after treatment of anaemia, the ventilatory requirement for carbon dioxide elimination being unchanged. Treatment of anaemia did not alter resting arterial lactate concentration; the concentration of lactate at maximum exercise was increased slightly following treatment but this increase did not reach statistical significance. The rate of increase in arterial lactate concentration as a function of oxygen consumption, assessed both with respect to the 'lactate threshold' and 'lactate slope index', was significantly delayed by treatment. Treatment of anaemia also delayed the 'anaerobic threshold', and there was good correlation between lactate and anaerobic thresholds. Treatment of renal anaemia by erythropoietin thus results in improved tissue oxygen supply during exercise, reflected by delay in the onset of lactic acidaemia.
对9名透析患者研究了用促红细胞生成素治疗终末期肾衰竭贫血的效果。血红蛋白浓度升高（从7.0±1.2g/dl增至11.1±1.1g/dl，增幅为59%）与运动持续时间增加（41%）和最大耗氧量增加（34%）相关。治疗使静息心率降低，但最大运动时心率及静息或运动血压无显著改变。治疗后静息动脉血钾浓度略有升高，但运动时与每分通气量的升高情况相似。在两个血红蛋白水平的运动过程中均出现乳酸性酸中毒，同时动脉血pH值和碳酸氢盐水平有类似降低，但动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）保持不变。在贫血治疗前后，通气与二氧化碳产生的代谢率、无效腔通气及动脉血二氧化碳分压相匹配，消除二氧化碳所需的通气量未变。贫血治疗未改变静息动脉血乳酸浓度；最大运动时的乳酸浓度在治疗后略有升高，但未达统计学显著差异。就“乳酸阈”和“乳酸斜率指数”而言，治疗显著延迟了动脉血乳酸浓度随耗氧量增加的速率。贫血治疗还延迟了“无氧阈”，且乳酸阈与无氧阈之间有良好的相关性。因此，用促红细胞生成素治疗肾性贫血可改善运动期间的组织氧供应，这表现为乳酸性酸中毒发作延迟。
