促红细胞生长素对充血性心衰患者心功能影响.docVIP

促红细胞生长素对充血性心衰患者心功能影响 　 作者：张勇，杜万红，黄洪波，肖创清，刘小阳 【摘要】 　　目的 探讨充血性心衰（CHF）并贫血的患者，在EPO加铁剂治疗后，对心脏结构与功能及B型利钠肽水平的影响。方法 32例连续CHF并贫血(80 g/L lt;血红蛋白lt;120 g/L)的患者纳入本研究。以随机方法分为治疗组(A组、16例)，皮下注射EPO 12 000 IU/周+每天口服铁剂共4个月。对照组(B组、16例)，每天口服铁剂。 结果 A组患者在随机治疗的4个月中，相对于基础状态血红蛋白增加(Plt;0．001)，左室内径缩小(Plt;0．001)，射血分数增加(Plt;0．05)，心功能分级(Plt;0．001)与6 min 步行试验(Plt;0．05)改善，同时血浆中B型利钠肽水平(Plt;0．01)下降。B组患者在试验期间射血分数(Plt;0．05)及6 min 步行距离(Plt;0．05)有所下降，其他指标无明显变化。结论 CHF并贫血 　　Abstract： Objective To study the effects of erythropoietin (EPO) plus oral iron on cardiac construction, function and Bnatriuretic peptide (BNP) level in patients with congestive heart failure (CHF) and anemia.Methods Thirtytwo consecutive subjects with CHF and anemia were enrolled into the study. They were randomized into trial group (Group A, n=16) and control group (Group B, n=16). Group A was administered hypodermal EPO for four months (12,000 iu/week) in addition to daily oral iron, and meanwhile Group B took daily oral iron alone. Results With respect to the baseline, the patients in Group A demonstrated an increase in hemoglobin (Plt;0.001), a reduction in left ventricular diastolic diameter (LVDD) (Plt;0.001), an increase in left ventricular ejection fraction (LVEF) (Plt;0.05), an improvement in new York Heart Association functional class (Plt;0.001) and 6-minute walking testing (Plt;0.05) and a decrease in plasma BNP level (Plt;0.01), and those in Group B showed a fall in LVEF (Plt;0.05) and in distance of 6-minute walking testing (Plt;0.05), and showed no differences in other indexes.Conclusion In anemic CHF patients, correction of anemia with EPO and iron leads to improvements in cardiac construction and function, and a fall in plasma BNP level. 　　Key words：congestive heart failure; anemia; cardiac construction; cardiac function; erythropoietin 充血性心衰(congestive heart failure，CHF)患者约有40%合并有贫血。年龄越大、心衰越重，贫血就更为常见与严重。一旦合并了贫血，常常预示着心功能的进一步恶化、运动能力进一步下降、住院率与死亡率均会上升[1～2]。尽管如此，在对CHF患者的处理中，贫血常常未被重视。促红细胞生长素(erythropoiefin，EPO)主要由肾脏和肝