Erythropoietin for infants with hypoxic-ischemic encephalopathy.
Erythropoietin for infants with hypoxic-ischemic encephalopathy.
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DOI：
10.1097/mop.0b013e328336eb57
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发表时间：
2010-04
影响因子：
3.6
通讯作者：
Juul SE
中科院分区：
文献类型：
--
作者：
McPherson RJ;Juul SE
围产期窒息、脑室内出血和脑卒中是新生儿脑损伤的常见原因，缺氧缺血是最终损伤的共同途径。促红细胞生成素（Epo）有可能减轻因缺氧缺血引起的神经系统后遗症。这篇综述的目的是强调新的临床试验和实验证据，扩大我们对促红细胞生成素作为一种潜在的治疗围产期脑损伤的理解。几项试验的促红细胞生成素治疗的审查：两个I/II期试验的高剂量促红细胞生成素给予早产儿建立药代动力学和安全性，并试验促红细胞生成素治疗足月婴儿中度缺氧缺血性脑病发现减少残疾。高剂量Epo的潜在风险和益处进行了讨论。本文综述了Epo受体表达、信号转导途径和神经保护机制的新证据。对于使用高剂量促红细胞生成素作为新生儿脑损伤的治疗选择，值得谨慎乐观。到目前为止，Epo在新生儿人群中使用是安全的，现在正在进行神经保护功效的研究。
Perinatal asphyxia, intraventricular hemorrhage and stroke are common causes of neonatal brain injury, with hypoxia-ischemia as the final common pathway of injury. Erythropoietin (Epo) has potential to lessen neurologic sequelae due to hypoxia-ischemia. The purpose of this review is to highlight new clinical trials and experimental evidence that expand our understanding of Epo as a potential treatment for perinatal brain injury. Several trials of Epo treatment are reviewed: Two phase I/II trials of high-dose Epo given to preterm infants established pharmacokinetic and safety profiles, and a trial of Epo treatment for term infants with moderate hypoxic-ischemic encephalopathy found reduced disability. Potential risks and benefits of high-dose Epo are discussed. New evidence related to Epo receptor expression, signal transduction pathways, and mechanisms of neuroprotection are reviewed. Cautious optimism is warranted regarding the use of high-dose Epo as a treatment option for neonatal brain injury. To date, Epo has been safe to use in neonatal populations and now studies of neuroprotective efficacy are underway.