Cerebral blood flow and vasodilatory capacity in anemia secondary to chronic renal failure
Cerebral blood flow and vasodilatory capacity in anemia secondary to chronic renal failure
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DOI：
10.1046/j.1523-1755.2002.00142.x
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发表时间：
2002-02-01
影响因子：
19.6
通讯作者：
Fujishima, M
中科院分区：
文献类型：
--
作者：
Kuwabara, Y;Sasaki, M;Fujishima, M
背景我们以前的研究报告，脑氧摄取分数（OEF）增加血液透析患者贫血。OEF增高提示脑血管舒张功能受损。为了阐明这一问题，我们使用正电子发射断层扫描（PET）测量了慢性肾功能衰竭（CRF）继发性贫血患者的CO2反应。10例CRF贫血患者（6女4男）和6名年龄匹配的正常对照。CRF的基础疾病为肾小球肾炎8例，系统性红斑狼疮（SLE）1例。1例患者合并高血压;在该队列中，5例患者正在接受血液透析治疗，其余5例患者处于血液透析前状态。采用O-15 H2O推注法测定脑血流量（CBF），每例患者均处于静息状态和吸入5%CO2期间。CO2反应以PaCO 2每变化1 mmHg时CBF变化的百分比来估计。与正常对照组相比，CRF贫血患者的CO2反应明显减弱，且与贫血的严重程度呈负相关。血液透析患者与血液透析前患者之间的CO2反应无显著差异。CO2反应与静息时CBF和脑氧代谢率（CMRO 2）显著相关，而与OEF和脑血容量（CBV）无相关性。本研究揭示了CRF贫血患者脑血管舒张能力降低的存在，表明慢性缺氧性脑损伤可能在对CO2的脑血管反应受损中发挥作用。
Background. Our previous study reported that cerebral oxygen extraction fraction (OEF) increased in hemodialysis patients with anemia. The increased OEF suggests that the cerebral vasodilatory capacity might be impaired in these patients. To clarify this issue, we measured the CO2 response in patients with anemia secondary to chronic renal failure (CRF) using positron emission tomography (PET).Methods. Ten anemic patients with CRF (6 females and 4 males) and 6 age-matched normal controls were studied. The underlying diseases of CRF were glomerulonephritis in 8 patients, systemic lupus erythematosus (SLE) in one patient. and hypertension in one patient; in this cohort, 5 patients were on hemodialysis treatment and the remaining 5 patients were in a pre-hemodialysis state. The cerebral blood flow (CBF) was measured by the O-15 H2O bolus injection method with each patient in a resting state and during 5% CO2 inhalation. The CO2 response was estimated as the percentage change of CBF per 1 mm Hg change of PaCO2.Results. The CO2 response was significantly attenuated in anemic patients with CRF in comparison to the normal controls, and it inversely correlated with the severity of anemia. There was no significant difference in the CO2 response between the hemodialysis and pre-hemodialysis patients. The CO2 response significantly correlated with CBF and the cerebral metabolic rate for oxygen (CMRO2) at rest, however, it did not correlate with OEF and cerebral blood volume (CBV).Conclusions. The present study revealed the existence of a reduced cerebral vasodilatory capacity in anemic patients with CRF, suggesting that chronic hypoxic brain damage might play a role in the impaired cerebrovascular response to CO2.