促红细胞生成素对高龄慢性心力衰竭并贫血患者的治疗作用

目的探讨促红细胞生成素(EPO)对高龄慢性充血性心力衰竭合并贫血患者的治疗作用。方法 108例诊断为慢性充血性心力衰竭患者中合并贫血58例纳入本研究。入选患者依顺序单双号法分为对照组与治疗组,各29例。对照组常规抗心力衰竭治疗,按常规剂量应用叶酸、铁剂等补充造血原料。治疗组在对照组治疗基础上,加用EPO 6000IU/周、皮下注射,治疗4个月。结果在高龄慢性充血性心力衰竭患者中贫血的发生率高;心力衰竭越重,贫血更为常见。两组治疗前各相关临床指标比较无差异(P>0.05)。对照组治疗前后比较,射血分数增加(P<0.05),但血红蛋白、左室内径、肾小球滤过率均无改善(P<0.05);治疗组治疗后与治疗前比较血红蛋白增加、左室内径下降、射血分数增高及肾小球滤过率提高,差异有统计学意义(P<0.05)。治疗组心脏结构与功能改善明显优于对照组。结论高龄慢性充血性心力衰竭合并贫血患者加用EPO治疗能更好地纠正贫血与改善心功能。     

左卡尼汀联合促红细胞生成素治疗慢性心力衰竭合并贫血患者的疗效

目的探讨左卡尼汀联合促红细胞生成素(EPO)对慢性心衰合并贫血病人心功能的改善作用。方法将43例慢性心衰合并贫血的病人随机分为治疗组23例和对照组20例。两组均予口服地高辛、速尿、螺内酯、维生素C及铁剂常规综合治疗,对照组仅应用左卡尼汀注射液,治疗组联合应用左卡尼汀注射液及EPO,共治疗16 w。分别检测治疗前后血红蛋白、血清游离脂肪酸(FFA)、红细胞膜Na+-K+ATP酶的活性及左心射血分数(LVEF)的变化。结果治疗组能明显提高慢性心衰合并贫血病人的血红蛋白水平、红细胞膜Na+-K+ATP酶活性及LVEF值,降低血清FFA的含量(P<0.01)。结论联合应用左卡尼汀及EPO可通过降低FFA含量、升高红细胞膜Na+-K+ATP酶活性,在纠正贫血状态的同时进一步改善心功能。     

促红细胞生成素治疗冠心病慢性心力衰竭合并贫血的临床观察

目的探讨促红细胞生成素（EPO）治疗冠心病慢性心力衰竭（CHF）合并贫血的临床效果。方法将138例冠心病CHF合并贫血的患者随机分为治疗组（A组）和对照组（B组）。B组患者给予常规药物治疗,A组患者在常规药物治疗的基础上加用EPO,使其血红蛋白浓度≥110g／L。随访6个月,观察两组患者的治疗效果。结果A组患者治疗后的总有效率明显优于B组（P〈0．05）。两组患者治疗后心功能分级、左室射血分数、左室舒张末内径、6min步行距离及BNP水平等均改善（P〈0．05）。与B组比较,A组患者上述各指标改善更显著（P〈0．05）。结论EPO可减轻冠心病CHF合并贫血患者的临床症状,提高疗效。     

类风湿关节炎贫血患者血清促红细胞生成素的观察

类风湿关节炎贫血患者血清促红细胞生成素的观察张育，张之南，于孟学，蒋明，杨江燕据报道，１６％～６５％的类风湿关节炎（ＲＡ）患者伴有轻度至中度贫血，但其机制尚未明了，我们对３７例ＲＡ患者血清促红细胞生成素（ＥＰＯ）水平进行了观察，并探讨ＥＰＯ水平的改变...     

慢性充自性心力衰竭患者促红细胞生成素测定

作者参照Ｂｅｓｓｌｅｒ介绍的胎鼠肝细胞定量测定法测定了７５例心衰患者血浆中的促红细胞生成素（ＥＰ）的含量。结果显示：心衰组血浆ＥＰ明显高于对照组（Ｐ＜０．０１），其中肺心病组＞高心病组＞冠心病组，差异有显著性。心功能Ⅲ级与Ⅳ级之间无显著性差异，但伴有肾肾功能不全者ＥＰ值下降。     

内源性促红细胞生成素与慢性心力衰竭

贫血常见于慢性心力衰竭(CHF)患者,其与CHF患者症状和心功能恶化以及死亡率增加有相关性。CHF患者内源性促红细胞生成素(EPO)水平上调,并与CHF严重程度相关。研究发现,EPO水平是CHF患者死亡和因心力衰竭再住院的强预测指标,并独立于血红蛋白水平以及其它已经确定的CHF严重程度的标志物。与非CHF患者相比,CHF患者EPO与血红蛋白水平仅呈弱相关性。     

促红细胞生成素治疗成人慢性肾衰贫血的几点建议

促红细胞生成素治疗成人慢性肾衰贫血的几点建议尹广关键词促红细胞生成素慢性肾衰贫血，缺铁性治疗中图法分类号Ｒ９７３１９９５年加拿大学者Ｍｕｉｒｈｅａｄ〔１〕等人在总结已发表的２００余篇有关临床应用促红细胞生成素文献的基础上，就基因重组人促红细胞生成素（...     

促红细胞生成素治疗慢性肾衰贫血有关的补铁问题

促红细胞生成素治疗慢性肾衰贫血有关的补铁问题尹广龚德华关键词促红细胞生成素慢性肾衰血清铁中图法分类号Ｒ９７３促红细胞生成素（ｅｒｙｔｈｒｏｐｏｉｅｔｉｎ，ＥＰＯ）及铁都是正常红细胞生成过程中必不可少的要素。临床上在应用ＥＰＯ治疗慢性肾衰患者的贫血时，...     

左旋肉碱与促红细胞生成素并用治疗尿毒症贫血

目的：观察左旋肉膜对重组人红细胞生成素（ｒ－ＨｕＥＰＯ）疗效的影响。方法：将４０例尿毒症血透患者随机分成两组。两组同时于血透后予以ｒ－ＨｕＥＰＯ１００￣１５０Ｕ／（ｋｇ．周）皮下注射。待血球压积（Ｈｃｔ）≥３０％后减量,维持Ｈｃｔ在３０％￣３５％。治疗组于每次血透后静脉推注左旋肉碱１．０ｇ,而对照组不用。血浆游离肉碱浓度采用放射化学酶联法测定。结果：治疗组血浆游离肉碱浓度及血红蛋白（Ｈｂ）、Ｈｃｔ     

促红细胞生成素结合左卡尼汀对老年慢性心衰合并贫血患者心功能的影响

目的探讨促红细胞生成素(EPO)结合左卡尼汀对老年慢性心衰合并贫血患者心功能的影响。方法回顾性分析该院2013年9月至2014年9月收治的47例老年慢性心衰合并贫血患者的临床资料,按照治疗方法分为对照组(23例)和观察组(24例),分别给予左卡尼汀治疗和EPO结合左卡尼汀治疗。观察两组治疗前后的血红蛋白含量以及红细胞膜Na~+、K~+、ATP酶活性、血清游离脂肪酸含量,并进行比较。结果治疗前两组各项指标比较均无统计学差异(均P0.05)。治疗后,两组各项指标比较均有统计学差异(均P0.05)。其中,观察组的血红蛋白含量以及红细胞膜Na~+、K~+、ATP酶活性均显著高于对照组,血清游离脂肪酸含量则显著低于对照组(P0.05)。结论 EPO结合左卡尼汀治疗老年慢性心衰合并贫血可以有效改善患者的心功能。     

Effects of DBcAMP on exercise capacity in patients with and without chronic heart failure

The acute effects of vasodilation on exercise capacity in cardiac patients with (group 1) and without (group 2) congestive heart failure were studied using dibutyryl cyclic AMP (DBcAMP). Exercise was performed on an upright bicycle ergometer using a graded protocol. DBcAMP increased cardiac output and decreased pulmonary capillary wedge pressure and systemic vascular resistance both at rest and during maximal exercise in these two groups. However, before and after DBcAMP neither exercise duration (371 +/- 52 seconds vs. 388 +/- 44, NS, in group 1, 645 +/- 148 vs. 635 +/- 143 seconds, NS, in group 2, respectively) nor maximal oxygen consumption (12.8 +/- 2.3 ml/kg/min vs. 13.1 +/- 1.6, NS, in group 1, 20.3 +/- 1.4 vs. 20.1 +/- 1.5, NS, in group 2, respectively) was improved. In both groups the arteriovenous oxygen differences were lower at rest and during exercise performed while on DBcAMP than in the control state. In group 2 patients excess vasoconstriction mediated by abnormally increased neurohormonal activities or edema were absent. Failure of the vasodilator to increase exercise capacity is probably due to nonspecific vasodilation and maldistribution of increased cardiac output, and not to tight vasoconstriction or narrowed arteriolar lumen.     

Effects of simulated altitude-induced hypoxia on exercise capacity in patients with chronic heart failure

PURPOSE: Patients with stable heart failure often wish to spend time at altitudes above those of their residence. However, it is not known whether they can safely tolerate ascent to high altitudes or what its effects on work capacity may be.SUBJECTS AND METHODS: We studied 14 normal subjects and 38 patients with clinically stable heart failure, 12 of whom had normal workload [peak exercise oxygen consumption (VO(2)) greater than 20 mL/min/kg], 14 of whom had slightly diminished workload (peak VO(2) 20 to 15 mL/min/kg), and 12 of whom had markedly diminished workload (peak VO(2) less than 15 mL/min/kg) at baseline. All performed cardiopulmonary exercise tests with inspired oxygen fractions equal to those at 92, 1,000, 1,500, 2,000, and 3,000 m, and maximum achieved work rates (mean +/- SD) were measured.RESULTS: All subjects completed the trial; no test was interrupted because of arrhythmia, angina, or ischemia. Maximum work rate decreased in parallel with increasing simulated altitude. The percentage decrease was greater for patients with heart failure and was most marked among those with the lowest workload at baseline. Maximum achieved work rate declined by 3% +/- 4% per 1,000 m in normal subjects, by 5% +/- 3% (P <0.01) in patients with heart failure with normal workload, by 5% +/- 4% (P <0.01) in patients with slightly diminished workload, and by 11% +/- 5% (P <0.01 vs normal subjects and vs the other patients with heart failure) in patients with markedly reduced workload.CONCLUSION: Patients with stable heart failure who ascend to higher altitudes should expect to have a reduction in maximum physical activity in proportion to their exercise capacity at sea level.     

促红细胞生成素辅助治疗慢性心力衰竭临床研究

目的：探讨促红细胞生成素（EPO）对慢性心力衰竭（CHF）患者的临床疗效及毒、副作用。方法：137例CHF患者被随机分成观察组（70例）和常规治疗组（67例）。常规治疗组采用常规治疗的利尿剂、地高辛、血管紧张素转换酶抑制剂（ACEI）等药物。观察组在常规组基础上皮下注射EPO 100 IU/kg,每周1次,疗程6个月。结果：与治疗前比较,治疗后两组左室射血分数[常规治疗组（33.36±5.07）%∶（37.59±4.62）%,观察组（32.03±4.87）%∶（40.75±6.11）%]、6 min步行距离[常规治疗组（365.15±62.00）m∶（412.52±41.00）m,观察组（354.00±63.55）m∶（491.70±68.00）m]、血红蛋白水平[常规治疗组（80.16±8.90）g/L∶（91.70±9.86）g/L,观察组（78.65±8.50）g/L∶（127.36±11.57）g/L]均显著提高,脑钠肽水平[常规治疗组（623.9±74.8）pg/ml∶（411.2±53.5）pg/ml,观察组（610.7±73.6）pg/ml∶（207.5±49.4）pg/ml]显著下降（P均〈0.05）,且观察组疗效明显优于常规治疗组（P均〈0.05）,两组治疗前后D-二聚体水平比较无显著差异（P〉0.05）。结论：促红细胞生成素能改善慢性心力衰竭患者的心功能,提高运动耐量,且未引起血栓。     

Effects of growth hormone on exercise capacity and cardiopulmonary performance in patients with chronic heart failure

BACKGROUND: Because GH exerted beneficial effects in various experimental models of heart failure, we investigated the effects of GH on physical exercise capacity and cardiopulmonary performance in patients with dilated cardiomyopathy and chronic heart failure (CHF). METHODS: Twenty-two patients with CHF (New York Heart Association functional class II-III) underwent spirometry and a symptom-limited, cardiopulmonary exercise testing before and after 3 months of GH (n = 11; seven males; seven idiopathic; 57 +/- 11 yr; 4 IU sc every other day) or placebo (n = 11; eight males; six idiopathic; 54 +/- 10 yr) administration, in a randomized, double-blind trial. Background CHF therapy remained unchanged. RESULTS: GH, but not placebo, increased IGF-I serum concentration (from 144 +/- 35 to 293 +/- 58 ng/ml; P < 0.005) and improved New York Heart Association functional class (from 2.4 +/- 0.5 to 1.8 +/- 0.4; P < 0.005), exercise duration (from 831 +/- 273 to 925 +/- 266 sec; P < 0.005), peak power output (from 245 +/- 127 to 280 +/- 132 W; P < 0.05), peak minute ventilation (from 52.5 +/- 16.1 to 61.3 +/- 17.3 liters/min; P < 0.05), peak oxygen consumption (from 19.8 +/- 5.6 to 25.1 +/- 5.6 ml/kg.min; P < 0.005), and anaerobic threshold (from 14.9 +/- 4.8 to 20.0 +/- 4.5 ml/kg.min; P < 0.005) without affecting lung function parameters. Furthermore, the slope of the relationship between minute ventilation and pulmonary carbon dioxide production (ventilatory efficiency) decreased from 34.7 +/- 5.1 to 31.7 +/- 5.3 (P < 0.005), whereas the slope of the relation between percent predicted heart rate reserve used and percent observed metabolic reserve used (chronotropic index) rose from 0.57 +/- 0.20 to 0.69 +/- 0.18 (P < 0.005). CONCLUSION: Given the predictive value of physical exercise capacity and cardiopulmonary performance in CHF progression, these data provide additional insights into the mechanisms by which GH may potentially benefit CHF patients.     

Ventilatory capacity and exercise tolerance in patients with chronic stable heart failure

BACKGROUND: Patients with chronic heart failure complain of breathlessness. This is associated with an increase in the ventilatory response to carbon dioxide production (VE/VCO(2) slope), yet a reduction in the maximal ventilation achieved at peak exercise. We analysed ventilatory capacity in heart failure in relation to exercise capacity. METHODS: We analysed data from 74 patients with chronic stable heart failure [age (S.D.) 50.6 (8.8) years; left ventricular ejection fraction 30 (15)%] and 36 controls [48.9 (11.5) years]. Subjects undertook maximal incremental exercise testing with metabolic gas exchange measurements to derive peak oxygen consumption (VO(2)), the VE/VCO(2) slope and ventilation. Spirometry was used to measure FEV(1) and FVC. Maximal voluntary ventilation (MVV) was calculated as FEV(1)x 35. RESULTS: Peak VO(2) was lower in patients [20.9 (7.5) ml min(-1) kg(-1) vs. 34.5 (10.1); P<0.001] and VE/VCO(2) greater [33.4 (10.7) vs. 26.0 (4.7); P<0.001]. Ventilation at peak exercise was lower in patients [63.5 (20.4) l/min vs. 86.9 (29.5); P<0.001], as was MVV [110.1 (37.9) l/min vs. 136.2 (53.1); P<0.001], but ventilation at peak as a proportion of MVV was the same in patients [60.0 (19.0)%] as controls [65.7 (12.4)%)]. There was an inverse relation between peak VO(2) and VE/VCO(2) slope (r=-0. 62; P<0.001). Percentage predicted FEV(1) correlated with ventilation at peak (r=0.62; P<0.001) and inversely with VE/VCO(2) slope (r=-0.32; P<0.001). There was no relation between percentage of MVV achieved and peak VO(2), or VE/VCO(2) slope. CONCLUSIONS: Although ventilation at peak exercise is lower in patients with heart failure than normal subjects, ventilation is the same proportion of maximal voluntary ventilation. These findings suggest that ventilatory capacity does not limit exercise capacity in heart failure.     

Effects of L-arginine on lower limb vasodilator reserve and exercise capacity in patients with chronic heart failure

OBJECTIVE: To determine whether the reactive hyperaemic response of the lower limb increases with improved exercise capacity after acute supplementation with L-arginine, the precursor of nitric oxide, in patients with chronic heart failure. METHODS: 19 patients with chronic heart failure were enrolled in the study. Rest calf blood flow and femoral occlusion induced calf blood flow changes were measured by venous occlusion plethysmography before and after intravenous infusion of 10% L-arginine solution (5 ml/kg for 30 minutes) or placebo. Postexercise calf blood flow was also measured after the experimental infusion. During both postinfusion periods, several exercise capacity indices were determined by a symptom limited cardiopulmonary exercise test using a bicycle ergometer. RESULTS: Baseline calf blood flow, systemic blood pressure, and heart rate showed no significant changes in either of the two experimental conditions. However, the occlusion induced blood flow response was significantly enhanced by L-arginine infusion (mean (SEM) peak flow, 19.6 (1.5) v 28.9 (3.1) ml/min/dl calf tissue; p < 0.01), but not by placebo (peak flow, 19.1 (1.4) v 20.9 (1.8) ml/min/dl calf tissue; NS). Calf blood flow response after exercise was also higher after L-arginine infusion than after placebo (peak flow, 4.8 (0.4) v 6.0 (0.8) ml/min/dl calf tissue; p < 0.05). L-arginine infusion had no significant effect compared with placebo on exercise capacity indices such as peak oxygen uptake (17.1 (1.0) v 15.8 (1.1) ml/min/kg; NS), anaerobic threshold (10.5 (0.6) v 10.4 (0.7) ml/min/kg; NS), and exercise time (296 (23) v 283 (22) s; NS). CONCLUSIONS: Acute supplementation with the nitric oxide precursor L-arginine increased lower limb reactive hyperaemia but did not lead to any significant improvement in exercise capacity in patients with chronic heart failure.     

Effect of flosequinan on exercise capacity and cardiac function in patients with chronic mild heart failure: A double-blind placebo-controlled study

Summary Although beneficial effects of a new vasodilating agent, flosequinan, have been demonstrated in patients with severe heart failure, its efficacy has not been studied in patients with a less severe form of chronic heart failure. In this study, the effects of 4 weeks' administration of flosequinan, 50mg daily, and placebo on exercise capacity, cardiac function, and symptoms of heart failure were investigated in 24 patients with chronic mild heart failure (New York Heart Association functional class, mainly class II) in a double-blind clinical trial. When the parameter changes during the treatment period of the flosequinan and placebo groups were compared, no significant difference was found in any of the measurements except for left ventricular fractional shortening determined from M-mode echocardiograms; it was increased by 2.9 ± 1.3% in the flosequinan group whereas it was decreased by 1.3 ± 0.9% in the placebo group (P < 0.05 vs flosequinan treatment). However, when compared to baseline values, flosequinan significantly increased exercise time in the symptom-limited maximal exercise test (704 ± 103 to 763 ± 107 s,P < 0.05) and the oxygen uptake at the anaerobic threshold (13.8 ± 1.3 to 16.7 ± 1.4ml/min kg,P < 0.05), and improved symptoms assessed with a new heart failure severity classification (a median value of 2.0–1.5,P < 0.05). These improvements were not observed in the placebo group. Serious adverse effects were not observed in either group. These results suggest that flosequinan is useful for the treatment of chronic mild heart failure as well as severe heart failure.Authors for the Osaka Flosequinan Multicenter Trial Group, members of which are listed in the Appendix