泌尿系统疾病

20053024 早期纠正贫血对慢性肾衰竭心血管病变影响的多中心临床研究/蒋建平…//中华内科杂志.-2005,44(1).-25～29 慢性肾衰(CRF)透析前患者158例,均按CRF常规治疗,包括低蛋白饮食、控制血压等。其中治疗组86例(Hb<110g/L),每周接受α-促红细胞生成素100～135U/kg皮下注射。对照Ⅰ组40例(Hb<110g/L),对照组Ⅱ组32例(Hb>110g/L),未接受α-促红细胞生成素治疗。3组基线临床资料无明显差异。治疗24个月后,治疗组Hb水平较基线时     

重组促红细胞生成素对慢性肾衰竭患者左心室重量和结构的影响

目的　观察用重组促红细胞生成素 (rHuEPO)改善贫血后对慢性肾衰竭患者左室重量和结构的影响。方法　将 2 4例慢性肾衰竭患者分为透析前组 (Ⅰ组 )和维持血透组 (Ⅱ组 ) ,在rHuEPO治疗前及治疗 4月后行血红蛋白 (Hb)测定和心脏超声检查。结果　rHuEPO治疗后Hb显著升高 (Ⅰ组 68g/L± 10 g/Lvs 10 1g/L± 11g/L ,Ⅱ组 67g/L± 6g/Lvs 94g/L± 8g/L ,P <0 .0 5 ) ;左室重量指数 (LVMI)显著下降 (Ⅰ组 185 .6± 44 .6vs 15 8.3± 44 .1,Ⅱ组 15 8.0± 2 6.9vs13 1.6± 2 2 .1,P <0 .0 5 ) ;两组左室收缩期末内径 (LVESD)及舒张期末内径 (LVEDD )均较治疗前显著下降 (P <0 .0 5 )。相关分析显示 ,Hb与左室重量和结构相关 ,贫血参与了左室肥厚 (LVH )的发生。结论　rHuEPO可引起LVMI下降 ,rHuEPO纠正贫血 ,有利于左室重量及结构异常的好转     

不同年龄组的高血压左室肥厚及依那普利干预试验

目的探讨依那普利逆转左室肥厚(LVH)的作用及其年龄的关系。方法90例高血压LVH病人按年龄被分为青年、中年、老年3组,予以依那普利治疗,设定治疗目标血压。于治疗前及后6个月分别作超声心动图检查,测量左室重量指数(LVMI),E、A波峰速等指标。结果依那普利能显著降低不同年龄组的LVMI(P<0.05～P<0.001),并改善左室舒张功能(P<0.05～P<0.01);青、中年组较老年组更为明显(P<0.05～P<0.01)。结论随着年龄的增长依那普利逆转左室肥厚的效果逐渐降低。     

一平苏逆转高血压病左心室肥厚的疗效及血压昼夜变化关系

目的本文探讨血管紧张素转换酶抑制剂一平苏(cilazapril)对高血压左心室肥厚(LVH)的逆转疗效及与患者血压昼夜变化特征的关系。 方法门诊确诊为LVH患者在停服各种血管活性药物2周后口服一平苏(cilazapril)2.5～5.0mg/d,并于治疗前及治疗后分别同时接受彩色多普勒心脏超声检查和24h动态血压监测,观察血压和左室质量指标(LVMI)的变化及与血压昼夜变化规律的关系。 结果服药18个月后,两组患者的诊室血压、24h动态血压和LVMI均较治疗前显著下降。但两组间血压下降值比较无显著性差异(P>0.05),并且动态血压分布特征无明显变化。但治疗组患者治疗后LVMI的下降值明显高于对照组(P<0.05)。并发现患者血压夜间下降≥10%者,治疗后LVMI下降值明显高于夜间血压下降不足10%者。 结论对高血压病LVH患者,一平苏(cilazapril)能有效地降低血压,逆转LVH。并对患者血压夜间下降幅度较大者,一平苏逆转LVH疗效更好。     

左室质量比值和左室质量指数对高血压左室重构识别的比较

目的比较左室质量比值(%PLM)和左室质量指数(LVMI)对左室重构识别的价值.方法对187例高血压患者进行超声心动图检查,测量其心脏结构和功能.结果左室质量适宜(aLVM)、过高(iLVM)和不足的分布分别占48.1%、48.7%和3.2%.%PLM与左室收缩功能的相关系数高于LVMI与左室收缩功能的相关系数.左室肥厚(LVH)时, iLVM的左室射血分数、左室短轴缩短率低于aLVM(P<0.01).但在aLVM或iLVM中,LVH和无LVH两组间的左室收缩功能无明显差异(P>0.05).结论 %PLM识别左室重构比LVMI更符合生理情况,更能精确地对高血压患者进行危险分层.     

Ⅰ-Ⅱ期高血压病患者昼夜长程心率功率谱改变及依那普利的干预影响

目的研究高血压患者心脏自主神经活性(A)昼夜节律改变及依那普利对其干预影响.方法对30例原发性高血压Ⅰ-Ⅱ期患者治疗前后和30例健康对照组进行心功率谱(HRPS)指标及昼夜节律分析,以及三维立体HRPS图制作.结果⑴、Ⅰ-Ⅱ期高血压组TP、VLF、LF、HF在深夜3～4 Am明显高于对照组(P<0.05),而LF/HF比值在各时段两组差异均不显著(P>0.05);⑵、治疗后对白昼HRPS指标无显著影响(P>0.05),而深夜3～4 Am时段TP、VLF、LF、HF分别下降25.2%(P<0.05)、27.1%(P<0.05)、16.8%(P>0.05)、25.0%(P<0.05);(3)、正常人,高血压Ⅰ-Ⅱ期患者,高血压合并冠心病、糖尿病、脑梗塞有各自特征性三维立体HRPS图表现.结论⑴、Ⅰ-Ⅱ期高血压患者夜间心脏交感和迷走神经活性均明显增强,该发现提示早期高血压自主神经活性有代偿性增强的病生改变;⑵、依那普利4周治疗能改善高NA血压病人夜间增强的心脏自主神经活性的峰值;(3)心功率谱分析的确具有研究、应用临床、评价心脏自主神经功能的实用价值,三维立体图特征明显,可望成为新型影像技术应用于临床.     

长期应用依那普利对高血压病患者左心室结构及QT离散度的影响

目的研究依那普利长期应用对高血压合并左室肥厚(LVH)的左室结构及QT间期离散度(QTd)的影响.方法观察32名原发性高血压患者每天口服依那普利5～10mg,平均18个月后,血压左室结构及QTd改变.结果用药后收缩压(SBP)和舒张压(DBP)显著降低(P<0.01),心率(HR)无明显改变(P>0.05).左室重量指数(LVMI)、室间隔厚度(lVST)及左室后壁厚度(PWT)明显减少(P<0.05).QTd显著降低(P<0.01).结论依那普利长期应用具有良好的降压效果,同时还可逆转LVH降低QTd,改善预后.     

培哚普利和卡维地洛对自发性高血压大鼠Ang Ⅱ和B型利钠肽的影响

目的转换酶抑制剂(ACEI)培哚普利和β-阻滞剂(BB)卡维地洛逆转左室肥大(LVH),本文旨在探讨药物干预下自发性高血压大鼠(SHR)血管紧张素(Ang Ⅱ)和B型利钠肽(BNP)水平改变的意义.方法 15周龄雄性SHR尾动脉测压,随机分三组未治疗组(n=7)、培哚普利组(n=6)、卡维地洛组(n=7).药物溶于蒸馏水以灌胃法给予,培哚普利8 mg/kg*-1、卡维地洛4 mg/kg*-1,疗程6周,未治疗组以等量蒸馏水灌胃.15周龄雄性WKY大鼠为正常血压对照组(n=8).实验结束断头处死,取血、分离左心室.采用高效液相色谱-放射免疫(HPLC-RIA)分析技术和RIA法测定各组大鼠血浆和心肌组织Ang Ⅱ和BNP(B型利钠肽)浓度.结果 (1)经6周治疗后SHR血压和左心室/体重比值较未治疗组有显著下降(P<0.05);(2)培哚普利能显著降低心肌组织Ang Ⅱ水平(P<0.05),但能明显升高血浆Ang Ⅱ水平(P<0.05);(3)卡维地洛显著降低血浆和心肌组织Ang Ⅱ水平(P<0.05);(4)无论培哚普利、卡维地洛都能使血浆和心肌组织的BNP水平降低(P<0.05).结论培哚普利、卡维地洛逆转LVH与其降低心肌组织Ang Ⅱ相一致,BNP可看作是Ang Ⅱ的天然拮抗物,随LVH逆转而下降,BNP下降反映治疗有效.     

DTI技术评价卡维地洛对高血压左室舒张功能的影响

目的评价卡维地洛对高血压左室舒张功能(LVDF)的影响.方法采用多普勒组织成像(DTI)技术分析正常人和轻中度高血压左室肥厚组(LVH组)和非左室肥厚组(非LVH组)患者的二尖瓣环的舒张早期、晚期运动速度(Ea、Aa),并与血流多普勒法检测的二尖瓣口舒张早期、晚期最大速度(E、A)比较,对 E/A和 Ea/Aa均<1者给予卡维地洛(10～20 mg/日)治疗12周,观察降压疗效及LVDF的变化.结果 1.高血压组Ea、Ea/Aa,E、E/A较正常组明显降低,A值明显升高(P<0.01),而Aa值二组间无差异.Ea、Ea/Aa在LVH组比非LVH组进一步降低(P<0.05),而E、E/A二组间无差异(P>0.05).2 卡维地洛作用用药12周后,SBP、DBP明显降低(P<0.01),心率无明显变化.Ea,Ea/Aa及E, E/A升高,非LVH组A值降低(P<0.05), LVH组A值无明显变化.结论 DTI技术可较血流多普勒法更敏感准确地反映严重LVDF受损患者的左室舒张功能.卡维地洛对轻中度高血压病具有良好降压作用并能改善左室舒张功能.     

生血宁片治疗糖尿病肾病腹膜透析患者肾性贫血的疗效

目的探讨生血宁片治疗糖尿病肾病腹膜透析患者肾性贫血的临床疗效。方法选取糖尿病肾病腹膜透析出现肾性贫血患者134例,按照随机数字表法分为研究组和对照组,每组67例,两组均给予重组人促红细胞生成素,研究组给予生血宁片治疗,对照组给予右旋糖酐铁治疗,比较两组临床疗效、血红蛋白(Hb)、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)、总氮排出量蛋白相当量(n PNA)、肌酐(Scr)、白蛋白(ALB)、超敏C反应蛋白(hs-CRP)以及不良反应。结果研究组总有效率为91.04%(61/67),显著高于对照组的80.59%(54/67)(P<0.05);两组治疗前后Scr和hs-CRP比较均无显著性差异(P>0.05),治疗后两组Hb、SF、TSAT均显著升高(P<0.05),且研究组高于对照组(P<0.05),治疗后研究组ALB、n PNA显著高于治疗前(P<0.05),且高于对照组(P<0.05),研究组不良反应发生率比对照组低(P<0.05)。结论生血宁片治疗糖尿病肾病腹膜透析患者肾性贫血能有效改善患者贫血状态,提高患者的营养状态,且对患者炎性反应无明显影响,不良反应较低。     

Effect of early correction of anemia with erythropoietin on left ventricular mass in predialysis patients: a multi-center trial

Objective To assess the effects of early correction of anemia with recombinant human erythropoietin (rHuEPO) on the development and progression of left ventricular hypertrophy (LVH) in patients with mild-to-moderate chronic renal insufficiency (CRI) who are not on hemodialysis. Methods A total of 158 patients with serum creatinine from 147μmol/L to 400μmol/L were enrolled in this prospective, multicenter study. Eighty-six patients with hemoglobin (Hb)<110g/L received rHuEPO treatment with a target Hb of > 110g/L (Group A). Forty patients with comparable Hb concentration ( <110g/L) but did not receive rHuEPO (Group B) and 32 patients with Hb≥110g/L and without rHuEPO treatment (Group C) were served as controls. Left ventricular mass index (LVMI) was evaluated by echocardiography at baseline and every 3 months for 2 years. Results There was no difference in age, gender, etiology of renal failure, blood pressure and cardiovascular risk factors among the 3 groups. At baseline, the prevalence of LVH was 72.1 % in group A, 72.5% in group B and 59.4% in group C. LVMI was inversely correlated with Hb levels (r=0.70, P<0.01). During the 2-year period, the mean LVMI decreased from 142.6±25.7g/m2 to 132.4±18.5 g/m2 in group A, while increased significantly in both group B and group C. The mean Hb concentration increased from 93.8±14.6g/L to 111.2±10.3g/L(P<0.05) in group A, but tended to decrease in group B and group C. There was no significant change of the mean blood pressure, number of anti-hypertensive drugs and serum creatinine concentrations in all 3 groups. However, patients' serum creatinine doubled more often in group B and group C than in group A. Conclusions LVH was common in predialysis CRI patients and was associated with the severity of anemia. Early intervention with rHuEPO may reverse LVH in these patients.     

Proven strategies to reduce cardiovascular mortality in hemodialysis patients

BACKGROUND: In hemodialysis patients, left ventricular hypertrophy (LVH) correlates with mortality. The reason for LVH in uremics is multifactorial. The primary objective of our study was to investigate the effects of a multi-interventional treatment strategy on LVH. METHODS: In 230 ambulatory patients, including patients with coronary artery disease, diabetes, diastolic and systolic dysfunction, we continued optimized cardiac therapy (beta-blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers) with full anemia correction by intravenous epoetin-beta. The dose of epoetin-beta for maintaining target hemoglobin (Hb) was 68 +/- 23 IU/kg/week. Serial echocardiograms were recorded every 3-6 months. The mean observation period was 4.8 +/- 1.2 years. RESULTS: Mean Hb at baseline was 11.2 +/- 2.0 versus 14.1 +/- 1.4 g/dl (p < 0.001) at study end. There was a significant reduction in left ventricular mass index (LVMI: 159 +/- 50.4 vs. 130.2 +/- 42.7 g/m(2); p < 0.001). In a subgroup of 2/3 of the patients, LVMI returned to normal (169 +/- 33 vs. 114 +/- 14 g/m2; p < 0.001). CONCLUSION: Baseline LVMI (p < 0.001), Hb increase (p < 0.03), and triple cardiac therapy (p < 0.03) were significant and independent prognostic factors for a reduction in LVMI. The annual cardiovascular mortality was 5%. Even anemia correction from 12 to 14 g/dl results in further (p < 0.001) regression of LVMI.     

Validity of the ECG diagnosis of left ventricular hypertrophy in normotensive and moderately hypertensive men when using the echocardiographic assessment of left ventricular mass index as reference.

The diagnostic validity of ECG criteria for left ventricular hypertrophy (LVH) was assessed in 100 men aged 22-64 (mean 47) years with moderate hypertension (Group 1) and 95 age-matched normotensive men (Group 2) using echocardiographic recordings of LV mass index (MI) as reference. A diagnosis of LVH was made in subjects with LVMI greater than or equal to 125 g/m2. Mean LVMI was 126 +/- 34 g/m2 in Group 1 vs. 100 +/- g/m2 in Group 2 (P less than 0.001), and the prevalence of LVH was 48% and 11% respectively (P less than 0.001). The mean ECG voltage according to Sokolow-Lyon (S-L) was 28 +/- 8 mm in Group 1 and 27 +/- 7 mm in Group 2 (NS); with 19% having LVH in Group 1 and 14% in Group 2 (NS). Using the Cornell criterion Group 1 had on average 15 +/- 6 mm vs. 12 +/- 5 mm in Group 2 (P less than 0.001), but only two Group 1 patients had LVH. In Group 2 a significant negative correlation between age and S-L voltage was found (r = 0.33, P less than 0.001). LVMI was not correlated with any of the two voltage criteria using linear regression analysis whereas multiple regression analysis revealed a weak, but significant correlation between LVMI and S-L voltage in Group 1 (t = 2.06, P = 0.04). No subject had LV strain pattern or LVH according to the Romhilt Estes point score system. In the assessment of possible LVH in normal or moderately hypertensive men less than 65-70 years of age, ECG has limited value.     

Comparison of the serum erythropoietin levels in chemotherapy-naive and cisplatin-treated cancer patients

There are conflicting data about the effects of cisplatin on erythropoietin (EPO) response to anemia. Aim of our study was to investigate whether endogenous EPO response to anemia in cisplatin treated patients was insufficient in comparison to the anemic chemotherapy-naive cancer patients and non cancer patients with iron deficiency anemia. Patients who had hemoglobin (Hb) levels of less than 110 g/l were included in the study. Fifteen chemotherapy- naive cancer patients were enrolled in Group A. Group B consisted of 15 patients who had been treated with three cycles of cisplatin chemotherapy and then became anemic and in Group C were included 15 patients who had iron deficiency anemia, without any malignancy. The mean Hb values were not different between all groups (102.8+/-39.8 g/l, 103.1+/-2.5 g/l and 99.3+/-3.6 g/l in Group A, Group B and Group C, respectively). However, EPO levels were found to be significantly lower in Group A and Group B than Group C (29.63+/-9.09 mU/ml, 20.87+/-2.43 mU/ml and 85.38+/-25.72 mU/ml, respectively; p=0.017 Group A vs. Group C, p=0.005 Group B vs. Group C). No significant difference was found between Group A and B (p=0.917). Opposite the iron deficiency anemia, cancer anemia is associated with an inadequate EPO response to anemia and administration of cisplatin does not lead to it further deterioration.     

Health, economic, and quality-of-life effects of erythropoietin and granulocyte colony-stimulating factor for the treatment of myelodysplastic syndromes: a randomized, controlled trial

In myelodysplastic syndromes (MDS), anemia responds to recombinant human erythropoietin (rHuEPO) alone and in combination with recombinant human granulocyte-colony-stimulating factor (rHuGCSF) in 10% to 20% and in 35% to 40% of patients, respectively. We randomly divided 60 patients with low-grade anemic MDS and serum EPO levels lower than 500 IU/L (500 mU/mL) into 2 groups: rHuEPO + rHuG-CSF (arm A) and supportive care (arm B). After 12 weeks, those who had erythroid responses were given rHuEPO alone for 40 additional weeks. They were also given rHuG-CSF if they had relapses. A response was considered major if the hemoglobin (Hb) level was 115 g/L (11.5 g/dL) or higher and minor Hb increase was 15 g/L (1.5 g/dL) or more or if it remained stable without transfusion. Ten of 24 patients responded in arm A, and 0 of 26 responded in arm B (P =.01). Eight patients in arm A continued rHuEPO therapy alone, and 6 had relapses. Responses were always restored when rHuG-CSF was reintroduced. Mean direct costs per patient were 26,723 euros (arm A) and 8,746 euros (arm B). Quality of life was assessed with a Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale. Similar percentages of patients from both arms showed significant clinical improvement. rHuEPO plus rHuG-CSF led to responses in 41.7% of MDS patients. This treatment was expensive. No effect on quality of life was demonstrated.     

代谢综合征患者过氧化物酶体增殖物激活受体δ+294T/C基因多态性与血脂、肥胖和左室肥厚的关系

目的探讨代谢综合征(MS)患者过氧化物酶体增殖物激活受体δ(PPARδ)+294T/C基因多态性与血脂、肥胖和左室肥厚的关系。方法检测300例MS、174例高血压病(EH)和143例2型糖尿病(DM)患者的体重指数(BMI)、腰围、血压、血脂、空腹血糖(FBG)和空腹血浆胰岛素(FINS)。MS诊断根据1999年WHO亚太诊断标准,其中389例患者行超声心动图检测心脏结构改变,应用聚合酶链反应-限制性片段长度多态性方法测定PPARδ+294T/C基因多态性。结果PPARδ+294T/C基因多态性各基因型频率分布组间比较差异无统计学意义。MS组血浆总胆固醇、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平和BMI明显高于DM组。MS组和EH组的左室重量(LVM)、左室重量指数(LVMI)和左室肥厚罹患率均明显高于DM组。MS组CC型血浆总胆固醇和LDL-C水平明显高于TT型和TC型[总胆固醇:CC型(6.13±1.86)mmol/L比TC型(5.14±1.10)mmol/L或TT型(4.99±1.42mmol/L),P<0.05或P<0.01;LDL-C:CC型(3.82±1.52)mmol/L比TC型(3.14±0.88)mmol/L或TT型(2.90±0.87)mmol/L,P<0.05或P<0.01]。分析PPARδ各基因型与LVMI和BMI的关系,发现MS组C等位基因携带者(CC+TC)LVMI和BMI明显高于TT型[LVMI:CC+TC(46±10)g/m2.7比TT(44±10)g/m2.7;BMI:CC+TC(26±3)kg/m2比TT(25±3)kg/m2,P<0·05]。结论MS患者PPARδ+294T/C基因多态性与肥胖和脂质紊乱关系密切,C等位基因携带者较TT基因型患者左室重构明显。     

L-carnitine supplementation decreases the left ventricular mass in patients undergoing hemodialysis.

BACKGROUND: Patients on long-term hemodialysis become deficient in carnitine and are frequently treated with carnitine supplementation to offset their renal anemia, lipid abnormality and cardiac dysfunction. The therapeutic value of carnitine supplementation on left ventricular hypertrophy (LVH) in patients with normal cardiac systolic function remains uncertain. METHODS AND RESULTS: The cardiac morphology and function of 10 patients given 10 mg/kg of L-carnitine orally, immediately after hemodialysis sessions 3 times per week for a 12-month period were compared with 10 untreated control patients. Using echocardiography, left ventricular fractional shortening (LVFS) and left ventricular mass index (LVMI) were measured before and after the study period. As a result, amounts of serum-free carnitine increased from 28.4+/-4.7 to 58.5+/-12.1 micromol/L. The LVMI decreased significantly from 151.8+/-21.2 to 134.0+/-16.0 g/m(2) in treated patients (p<0.01), yet the LVMI in untreated control patients did not change significantly (ie, from 153.3+/-28.2 to 167.1+/-43.1 g/m(2)). However, LVFS values remained unchanged in both groups. Although L-carnitine promoted a 31% reduction in erythropoietin requirements, hematocrit and blood pressure did not change during the study period. CONCLUSIONS: Supplementation with L-carnitine induced regression of LVH in patients on hemodialysis, even for those with normal systolic function.     

Association of anemia with diastolic dysfunction among patients with coronary artery disease in the Heart and Soul Study

We performed a cross-sectional study to evaluate the association of anemia with diastolic dysfunction and left ventricular hypertrophy (LVH) in outpatients who had coronary artery disease. Logistic regression was used to examine the association of blood hemoglobin (Hb) concentrations with diastolic dysfunction and LVH in 822 participants in the Heart and Soul Study who had normal sinus rhythm and preserved systolic function (left ventricular ejection fraction >/=50%). Using transthoracic echocardiography, diastolic dysfunction was defined as diastolically dominant pulmonary vein flow, and LVH was defined as left ventricular mass index >90 g/m(2). Anemia (Hb <13 g/dl) was present in 24% of participants (197 of 822). The prevalence of diastolic dysfunction ranged from 8% in participants who did not have anemia (Hb >/=13 g/dl) to 13% in those who had moderate anemia (Hb 11 to 13 g/dl) to 24% in those who had severe anemia (Hb <11 g/dl, p = 0.004 for trend). After multivariable adjustment, moderate anemia (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.1 to 3.6) and severe anemia (OR 6.6, 95% CI 1.9 to 24.9) remained strongly associated with diastolic dysfunction. In contrast, moderate anemia (OR 1.4, 95% CI 1.0 to 2.1) and severe anemia (OR 1.6, 95% CI 0.6 to 4.6) were not significantly associated with LVH. We found anemia to be strongly associated with diastolic dysfunction but not with LVH in this community-based sample of outpatients who had established coronary disease.     

心力衰竭患者血红蛋白水平与神经内分泌细胞因子关系及对心室重构的影响

目的 探讨慢性心力衰竭(CHF)患者血红蛋白(Hb)水平变化与神经内分泌激素、细胞因子和B型钠尿肽(BNP)的关系及对心室重构的影响.方法 对入选的121例CHF患者测定Hb、血管紧张素Ⅱ(Ang Ⅱ)、肿瘤坏死因子(TNF)-α、一氧化氮(NO)、细胞间黏附分子(ICAM)-1、BNP水平,超声心动图测量左室射血分数(LVEF),评价心功能,计算左心室质量指数(LVMI)和平均室壁应力(MWS);CHF患者按Hb水平分为贫血组和非贫血组.同时选择27例健康人为对照组.结果 CHF组患者AngⅡ、TNF-α、NO和ICAM-1、BNP水平以及LVMI和MWS高于对照组(均为P＜0.01),而Hb水平和LVEF低于对照组;随着Ang Ⅱ、TNF-α、NO、ICAM-1、BNP水平以及MWS和LVMI升高,Hb水平逐渐降低,心功能指标下降;CHF贫血组Ang Ⅱ、TNF-α、NO、ICAM-1、BNP水平及MWS和LVMI高于非贫血组,分别[为(144.5±64.1)ng/L与(76.7±48.5)ng/L、(92.3±6.4)ng/L与(55.6±10.2)ng/L、(65.2±4.2)μmol/L与(42.1±11.9)μmol/L、(253.6±26.0)μg/L和(237.2±33.3)μg/L、(1294.0±223.0)ng/L与(437.0±115.0)ng/L、P＜0.01];随着AngⅡ、TNF-α、NO、ICAM-1、BNP水平以及MWS和LVMI进一步升高,CHF患者贫血程度加重;CHF患者Hb与AngⅡ、TNF-α、NO、ICAM-1、BNP水平及LVMI和MwS均呈负相关(r分别为-0.8173、-0.8509、-0.6001、-0.6692、-0.6283、-0.8604、-0.8733,P＜0.01).结论 CHF患者神经内分泌激素激活、细胞因子过度表达参与了心室重构和贫血发生发展的病理过程,而贫血使心室重构程度加重.     

Erythropoietin Administration May Potentiate Mobilization of Storage Iron in Patients on Oral Iron Chelation Therapy

Five, repeatedly transfused, patients with refractory anemia (RA) or RA with ringed sideroblast (RARS) subtypes of myelodysplastic syndrome (MDS), with serum ferritin (SF) levels of >2,000 μg/L, and one female with Hb E [β26(B8)Glu→Lys]/β⁰-thalassemia (thal) with an SF level of 1,760 μg/L, were treated with deferiprone (L1) at the dose of 4–6 g per day for at least 26 months. Beginning in the second month, all patients received recombinant human erythropoietin (rHuEPO) at the dose of 150 IU/kg thrice weekly, subcutaneously for 24 months. A significant increase in iron excretion after combined administration of L1 and rHuEPO compared to treatment with L1 as a single agent, was observed in all patients. The amount of excreted iron in urine ranged from 7.5 to almost 20 mg per day. In one patient, a response to rHuEPO resulted in transfusion independence and her SF decreased from 2086 to 879 μg/L. In four MDS patients, who remained dependent on red blood cell (RBC) transfusions, simultaneous administration of L1 and rHuEPO enabled the stabilization of SF levels, despite continuing iron load from the transfusions. Combined administration of rHuEPO and oral iron chelators may potentiate mobilization of storage iron and maintain iron balance in transfusion-dependent iron overloaded early MDS patients.