エリスロポエチンによる貧血改善後に生じた血圧上昇と循環動態の変化

Effect of recombinant human erythropoietin administration on cardiovascular system in patient with chronic renal failure:An analysis of the blood pressure upward

　近年のバイオテクノロジーの進歩によりエリスロポエチンの製造が可能となり，慢性維持透析患者の貧血治療において大きな期待が持たれている。エリスロポエチンの造血促進作用は大きく，短期間にヘマトクリット（Ht）の上昇が得られるため，種々の循環動態に及ぼす影響が考えられる。さらにエリスロポエチンによる貧血改善に際し，血圧上昇をきたす例のあることも知られてきた。そこで対象を，エリスロポエチン治療後血圧が上昇した血圧上昇群（HT群）と，血圧が正常にとどまった正常血圧群（NT群）に分け，その背景をなす循環動態の変化について検討した。

To investigate the mechanism of blood pressure upward after recombinant human erythropoietin (EPO) administration in patient with chronic renalfailure (CRF), hemodynamic changes following on the improvement of anemia was evaluated by the echocardiography.

Fourteen (5 males, 9 females) normotensive patients with less than 23% of hematocrit (HT) were ad-ministered 1,500~3, 000 units of EPO three times a week. Four patients with systolic (>160 mmHg) or diastolic (>90 mmHg) hypertension after EPO administration was named group H, the remaining patients was named group N. Blood pressure, heart rates and parameters of echocardiography examined after the improvement of anemia were compared to those examined before EPO administration, respec-tively.

Patients had an increase in Ht from 20. 0 ±1. 6% to 33. 0 ±1. 9% (p <0. 01). LVDd, LVEDV, CO and flow velocity in group N were significantly decreased after EPO administration ; while those in group H did not show the significant changes. IVSth and LVPWth in each group were significantly increased after EPO administration.

These data showes that decrease in CO maintains the patients normotensive after EPO administration.