Martin G R, Ongkingo J R, Turner M E, Skurow E S, Ruley E J
Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Pediatr Nephrol. 1993 Jun;7(3):276-80. doi: 10.1007/BF00853220.
To determine the effects of anemia in children with end-stage renal disease, we studied cardiac performance before and 1 and 6 months after recombinant erythropoietin (Epogen). Children with end-stage renal disease were included if they had significant anemia [hematocrit (Hct) < 30%]. Epogen 50 U/kg was given subcutaneously or intravenously three times per week until the Hct was > or = 33%. Echocardiography, cardiac output (acetylene rebreathing), and treadmill (modified Bruce) tests were performed. Boys (9) and girls (9), 11.9 +/- 5.6 years, were given Epogen and the Hct increased (from 21.7 +/- 2.7% to 33.4 +/- 2.1%, P = 0.001). Heart rate decreased (P = 0.04) and stroke volume did not change. Blood pressure did not change. Cardiac thickness, chamber dimensions, left ventricular wall stress, velocity of circumferential fiber shortening, and indices of diastolic function were normal and did not change after Epogen. Exercise time increased (from 10.3 +/- 1.9 to 11.2 +/- 1.9 min, P = 0.01) after 1 month of Epogen. Resting oxygen consumption (VO2) decreased (from 7.8 +/- 1.8 to 6.9 +/- 1.4 ml/min per kg, P = 0.01) 1 month after Epogen and peak exercise VO2 did not change after Epogen. There were no differences in exercise tests between the 1 and 6 month measurements. Exercise tolerance improves after the short-term correction of anemia and there is no further improvement after long-term correction.
为了确定终末期肾病患儿贫血的影响，我们研究了重组促红细胞生成素（爱普列特）治疗前、治疗1个月和6个月后的心脏功能。终末期肾病患儿若有显著贫血（血细胞比容<30%）则纳入研究。每周皮下或静脉注射爱普列特50 U/kg，共3次，直至血细胞比容≥33%。进行了超声心动图、心输出量（乙炔再呼吸法）和跑步机（改良布鲁斯方案）测试。9名男孩和9名女孩，年龄11.9±5.6岁，接受了爱普列特治疗，血细胞比容升高（从21.7±2.7%升至33.4±2.1%，P = 0.001）。心率下降（P = 0.04），而每搏输出量未改变。血压未改变。心脏厚度、腔室大小、左心室壁应力、圆周纤维缩短速度和舒张功能指标均正常，爱普列特治疗后未发生变化。爱普列特治疗1个月后运动时间增加（从10.3±1.9分钟增至11.2±1.9分钟，P = 0.01）。爱普列特治疗1个月后静息耗氧量（VO2）下降（从7.8±1.8降至6.9±1.4 ml/min per kg，P = 0.01），爱普列特治疗后运动峰值VO2未改变。1个月和6个月测量的运动测试结果无差异。短期纠正贫血后运动耐量改善，长期纠正后无进一步改善。
