Keselbrener L, Korzets A, Akselrod S
Center for Medical Physics, Tel Aviv University, Israel.
Clin Auton Res. 1997 Dec;7(6):333-6. doi: 10.1007/BF02267727.
Previous studies have reported that anemia is a frequent occurrence in patients with severe autonomic failure, that it can be corrected by exogenous erythropoietin and that upright blood pressure improves while on erythropoietin. The objective of this study was to determine the alteration of autonomic control during erythropoietin therapy in a patient with severe autonomic failure and severe symptomatic orthostatic hypotension, evaluated by spectral analysis of heart rate variability. The autonomic response to standing was evaluated before, after 1 month and after 6 months of erythropoietin therapy. The results were compared to an age- and sex-matched control adult. There was no improvement in the orthostatic hypotension during and at the end of the erythropoietin treatment despite an increase in hemoglobin from 9.6 g/dl before treatment to 12.5 g/dl during treatment. The spectral estimates of heart rate variability displayed a low variability at baseline, a paradoxical vagal enhancement and a lack of sympathetic increase on standing (before, during and at the end of the treatment). There was no improvement of baseline activity, nor of the response to standing during and at the end of the treatment with erythropoietin. We conclude that erythropoietin did not improve the autonomic response to standing, although it corrected anemia. Erythropoietin did not alter sympathetic activity, as reflected in the low frequency content of the power spectrum of heart rate fluctuations during and at the end of treatment.
既往研究报道，贫血在严重自主神经功能衰竭患者中很常见，外源性促红细胞生成素可纠正贫血，且使用促红细胞生成素时直立位血压会改善。本研究的目的是通过心率变异性频谱分析，确定在促红细胞生成素治疗期间，一名严重自主神经功能衰竭和严重症状性直立性低血压患者的自主神经控制变化情况。在促红细胞生成素治疗前、治疗1个月后和治疗6个月后，评估对站立的自主神经反应。将结果与年龄和性别匹配的成年对照者进行比较。尽管血红蛋白水平从治疗前的9.6 g/dl升至治疗期间的12.5 g/dl，但在促红细胞生成素治疗期间及治疗结束时，直立性低血压并无改善。心率变异性的频谱估计显示，在基线时变异性较低，站立时出现矛盾的迷走神经增强且交感神经无增加（治疗前、治疗期间和治疗结束时）。在促红细胞生成素治疗期间及治疗结束时，基线活动以及对站立的反应均未改善。我们得出结论，促红细胞生成素虽纠正了贫血，但并未改善对站立的自主神经反应。促红细胞生成素并未改变交感神经活动，这在治疗期间及治疗结束时心率波动功率谱的低频成分中有所体现。
