健脾生血片治疗慢性心力衰竭伴贫血的临床效果

目的:探索健脾生血片治疗慢性心力衰竭伴贫血的疗效、安全性和作用机制。方法:选取2016年5月至2017年2月同济医院收治的慢性心力衰竭贫血患者144例,按照随机数字表法分为观察组和对照组,每组72例。观察组给予健脾生血片治疗,3片/次,3次/d,疗程3个月;对照组给予生血宝合剂治疗,15 m L/次,3次/d,3个月为1个疗程。比较2组患者治疗前与治疗后血红蛋白、红细胞计数、网织红细胞、血清铁、转铁蛋白饱和度、血清铁蛋白、血清铁调素(Hepcidin)、血清IL-1β、血清肿瘤坏死因子-α(TNF-α)、血清C反应蛋白(CRP)、左室射血分数(LVEF)、6 min步行距离、明尼苏达心力衰竭生命质量量表(MLHFQ)和不良事件。并随访2组心血管事件次数,住院次数与全因死亡率。结果:观察组72例患者完成了前3个月的治疗,随访期间脱失2例;对照组治疗期间1例患者退出研究,随访期间脱失4例。2组一般资料比较,差异无统计学意义(P 0. 05),具有可比性。观察组贫血有效率98. 6%,对照组有效率11. 3%,差异有统计学意义(P0. 05)。治疗后观察组红细胞计数和网织红细胞、均显著高于对照组(P 0. 05)。观察组血清铁、转铁蛋白饱和度水平均高于对照组,差异有统计学意义(P 0. 05),但血清铁调素水平显著低于对照组,差异有统计学意义(P 0. 05),血清铁蛋白水平2组差异无统计学意义(P 0. 05)。观察组IL-1β、血清TNF-α、血清CRP均显著低于对照组,差异有统计学意义(P 0. 05)。观察组LVEF、6 min步行距离、明尼苏达心力衰竭生命质量量表(MLHFQ)均显著高于对照组,差异有统计学意义(P 0. 05)。2组不良事件总发生率比较,差异无统计学意义(P 0. 05),但对照组4例患者出现血清肌酐、尿素氮水平异常,发生率高于观察组,差异有统计学意义(P 0. 05)。经1年随访,观察组心血管事件人均发生次数显著少于对照组(P 0. 05),但2组住院次数和全因死亡率比较,差异无统计学意义(P 0. 05)。结论:健脾生血片可有效治疗心力衰竭伴贫血,减少心血管发生次数,并且安全性良好,其作用机制与提供准确足量铁元素、抑制铁调素表达,抑制慢性炎性反应有关。     

Nutrition for pregnancy after metabolic and bariatric surgery: literature review and practical guide

When pregnancy follows metabolic and bariatric surgery (MBS), there are many important considerations related to nutritional status that may impact maternal and infant outcomes. Although evidence-based nutrition guidelines for pregnancy exist for the general population, there are limited practical recommendations that specifically address pregnancy after MBS. A literature search was conducted to investigate outcomes of women with a history of MBS and pregnancy. Search criteria focused on women 18 years of age and older who became pregnant after MBS. Search terms included “laparoscopic sleeve gastrectomy,” “Roux-en-Y gastric bypass,” “laparoscopic adjustable gastric banding,” “biliopancreatic duodenal switch,” and gestation terminology, and they were paired with the nutrition outcomes of interest. A total of 167 publications were identified; 46 articles were included in the final review. Data relating to gestation and fetal weight and nutrition and cardiometabolic data were extracted from the studies. Based on this review, women of childbearing age with a history of MBS should be evaluated and monitored for nutritional status before conception, during pregnancy, and postpartum.     

补中益气颗粒联合多糖铁复合物治疗妊娠期缺铁性贫血疗效和安全性分析

目的：探讨补中益气颗粒联合多糖铁复合物治疗妊娠期缺铁性贫血（IDA）的临床疗效。方法：将120例妊娠期IDA患者按照随机数字表法分为2组，每组60例。对照组给予多糖铁复合物治疗，研究组给予补中益气颗粒联合多糖铁复合物治疗，均用药4周。比较2组治疗前后红细胞（RBC）计数、血红蛋白（Hb）含量、平均红细胞血红蛋白含量（MCH）、血清铁（SI）、血清铁蛋白（SF）、铁调素和可溶性转铁蛋白受体（sTfR），以及2组治疗总有效率、不良反应和不良妊娠结局发生率。结果：治疗后研究组RBC、Hb、MCH、SI和SF均高于对照组，铁调素和sTfR低于对照组，治疗总有效率高于对照组，差异均有统计学意义（均P＜0.05）。2组不良反应发生率和不良妊娠结局发生率差异无统计学意义（P＞0.05）。结论：补中益气颗粒联合多糖铁复合物可有效改善铁代谢，治疗妊娠期IDA效果显著，安全性较好。     

Prevalence and spectrum of iron deficiency in heart failure patients in south Rajasthan

ObjectiveTo estimate the prevalence and pattern of iron deficiency (ID) in heart failure (HF) patients with or without anemia.MethodsThis is a single-center observational study, conducted at a tertiary care hospital of south Rajasthan. Patients admitted to hospital with clinical diagnosis of HF based on validated clinical criteria were included in the study. ID was diagnosed based on complete Iron profile, including serum iron, serum ferritin, total iron binding capacity, and transferrin saturation (TSAT). Anemia was defined as hemoglobin (Hb) <13 g/dl for males and <12 g/dl for females, based on World Health Organization definition. Absolute ID was taken as serum ferritin < 100 μg/L and functional ID was defined as normal serum ferritin (100–300 μg/L) with low TSAT (<20%).ResultsA total of 150 patients of HF (68% males and 32% females) were studied. Most of the patients were of high-functional NYHA class (mean NYHA 2.89 ± 0.95). ID was present in 76% patients with 48.7% patients having absolute and 27.3% patients having functional ID. Females were having significantly higher prevalence of ID than males (91.6% vs 68.6%; p = 0.002). Nearly one-fourth of the patients were having ID but without anemia, signifying importance of workup of ID other than Hb.ConclusionOur study highlights the yet underestimated and neglected burden of ID in HF patients in India. This study suggests further large-scale studies to better characterize this easily treatable condition and considering routine testing in future Indian guidelines.