入院时凝血酶原活动度与慢性心力衰竭患者发生院内死亡的关系

【摘要】目的 探讨入院时凝血酶原活动度(PTA)与慢性心力衰竭(CHF)患者发生院内死亡的关系。方法 回顾性选取我院(2017年1月～2020年1月)215例院内死亡CHF患者为院内死亡组，根据1:1配比，选取同时期没有发生院内死亡的CHF患者为存活组，对比两组基线资料，Pearson或点二列相关系数分析PTA与CHF患者基线资料的相关性，多因素Logistics回归分析CHF患者院内死亡影响因素，ROC曲线分析危险因素对CHF患者院内死亡的预测价值。结果 院内死亡组PTA明显低于存活组(P＜0.05)；Pearson或点二列相关系数分析显示，PTA与性别、总胆红素(TBil)、γ-谷氨酰基转移酶(GGT)、血红蛋白(Hb)、脑钠肽(BNP)呈负相关，与总胆固醇(TC)、白蛋白(Alb)、血小板计数(PLT)呈正相关(P＜0.05)；多因素Logistics回归显示，结果显示，Alb(OR=1.091，95%CI=1.037～1.147)、Hb(OR=0.883，95%CI=0.850～0.918)、PTA(OR=1.072，95%CI=1.022～1.288)降低和BNP(OR=1.005，95%CI=1.002～1.007)升高为CHF患者院内死亡独立危险因素(P＜0.05)；ROC曲线显示，PTA预测CHF患者院内死亡的曲线下面积(AUC)、敏感度、特异度、准确度为0.828、85.12%、72.56%、76.28%。结论 院内死亡CHF患者PTA明显降低，为院内死亡发生独立危险因素，可作为预测CHF患者院内死亡的指标。     

贫血对慢性心力衰竭患者住院期间死亡的影响

目的:了解慢性心力衰竭(CHF)患者贫血的发生率及其对住院期间死亡的影响。方法:收集2003-01-2008-06在我院住院的CHF患者的临床资料进行回顾性分析,根据患者血红蛋白(Hb)水平分为Hb正常组、轻度贫血组以及中重度贫血组3组。结果:贫血在CHF患者的发生率为32·5%;住院期间死亡患者的Hb、RBC均明显低于好转的患者(P0·01),贫血患者在住院期间的死亡率明显高于无贫血的患者(P0·01),以二分类Logistic回归住院期间死亡的危险因素进行分析得出:贫血的偏回归系数为1·296(P=0·039),优势比(OR)为3·655(95%CI:1·069~12·499);对于心功能NYHAⅢ~Ⅳ级的CHF患者,Hb的偏回归系数为-0·073(P=0·041),OR为0·93(95%CI:0·864~0·995)。结论:CHF患者贫血的发生率较高,贫血是CHF患者住院期间死亡的独立危险因素,Hb降低增加心功能Ⅲ~Ⅳ级的CHF患者住院期间的死亡。     

脑钠肽与高龄患者支架置入术预后的关系

目的研究术前脑钠肽(BNP)水平与高龄不稳定型心绞痛(UAP)患者冠状动脉介入术(PCI)后全因死亡的预测价值。方法该研究为回顾性研究,连续入选长海医院于2015年1月至12月行PCI治疗且年龄≥75岁的UAP患者311例,收集其临床资料,随访终点为全因死亡或术后2年。根据术前BNP水平将患者分为BNP100 pg/ml组(n=197),100 pg/ml≤BNP300 pg/ml组(n=71),和BNP≥300 pg/ml组(n=43)。绘制Kaplan-Meier生存曲线;采用Cox比例风险回归模型分析BNP对高龄PCI患者预后的影响。结果平均随访22.6±4.3月,术后6月、1年和2年累积全因死亡率分别为1.3%、4.2%和8.5%。与另两组比较,BNP≥300 pg/ml组陈旧性心肌梗死病史、NYHA心功能Ⅲ/Ⅳ级患者较多,血肌酐更高,差异有统计学意义(P均0.05)。BNP100 pg/ml组、100 pg/ml≤BNP300 pg/ml组和BNP≥300 pg/ml组术后2年全因死亡率分别为4.4%、9.9%和25.6%,差异有统计学意义(P0.05)。多因素Cox回归分析显示,在校正了包括年龄、性别、NYHA心功能Ⅲ/Ⅳ级、血红蛋白等因素后,BNP≥300 pg/ml(RR=4.822,95%CI:2.183～10.650)、血肌酐≥110μmol/L(RR=2.930,95%CI:1.327～6.468)均是高龄UAP患者全因死亡的独立危险因素。结论术前BNP水平与高龄UAP患者PCI预后相关,BNP≥300 pg/ml的患者全因死亡风险较大。     

促红细胞生成素及血红蛋白与老年慢性心力衰竭患者的相关性

目的探讨促红细胞生成素(EPO)和血红蛋白(Hb)与慢性心力衰竭(CHF)的相关性。方法选择老年CHF患者1 69例,根据本次住院确诊的心功能(NYHA)Ⅰ、Ⅱ、Ⅲ和Ⅳ级依次分为1组33例、2组34例、3组59例和4组4 3例。对4组患者Hb、EPO及是否死亡进行logistic回归分析。结果与1组比较,2、3和4组lg EPO水平明显上升,Hb水平明显下降(P<0.01);4组患者lg EPO和Hb水平两两比较,差异均有统计学意义(P<0.01)。Hb、EPO及肌酐(OR=0.978,35.820,1.013,P<0.01)均是影响老年CHF患者住院死亡的危险因素。结论 EPO随患者CHF程度的加重而升高,Hb值则降低。Hb、EPO及肌酐均为影响CHF患者住院死亡的危险因素。     

心脏彩色超声和心肌收缩力储备及B型钠尿肽评估老年慢性心力衰竭长期预后的价值

目的探究心脏彩色超声检查联合心肌收缩力储备(MCR)、血浆B型钠尿肽(BNP)水平在评估老年慢性心力衰竭患者长期预后的价值。方法选取2015年1月～2017年1月我院收治的老年慢性心力衰竭患者138例,随访3年,根据是否发生心源性死亡分为存活组105例和死亡组33例,收集心脏彩色超声指标[左心室内径(LVD)、左心房内径(LAD)]、MCR、BNP水平。采用logistic回归分析长期预后的危险因素;采用ROC曲线评估心脏彩色超声联合MCR、血浆BNP水平对老年慢性心力衰竭患者长期预后的预测价值。结果 138例患者中,死亡33例(23.91%)。死亡组LVD、LAD、BNP水平明显高于存活组,MCR明显低于存活组,差异有统计学意义(P0.01)。logistic回归分析显示,LVD、LAD、BNP是老年慢性心力衰竭患者长期预后的危险因素(95%CI:1.015～3.062,P=0.044;95%CI:1.070～3.124,P=0.027;95%CI:1.054～1.417,P=0.008),而MCR是保护因素(95%CI:0.027～0.526,P=0.005)。ROC曲线分析显示,LVD、LAD、MCR、BNP预测长期预后的曲线下面积依次为0.702(95%CI:0.593～0.812)、0.767(95%CI:0.673～0.861)、0.795(95%CI:0.706～0.884)、0.857(95%CI:0.779～0.934),四项联合预测老年慢性心力衰竭患者长期预后的曲线下面积为0.996(95%CI:0.988～1.000),明显高于LVD、LAD、MCR、BNP单项检测(P0.05)。结论心脏彩色超声检测LVD、LAD,联合MCR、BNP对老年慢性心力衰竭患者长期预后具有较高的预测价值。     

流感疫苗接种对心力衰竭患者结局影响的Meta分析

目的:采用Meta分析方法评价流感疫苗接种对心力衰竭患者全因死亡和住院的影响。方法:计算机检索PubMed、EMbase、The Cochrane Library、CBM、CNKI、WanFang Data和VIP数据库,搜集流感疫苗接种对心力衰竭患者全因死亡和住院影响的观察性队列研究,检索时限均为建库至2019年2月1日。由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Review Manager 5.3软件进行Meta分析。结果:共纳入7个研究,包括156 544例患者。流感疫苗接种降低心力衰竭患者的全因死亡风险[RR=0.72,95%CI(0.63,0.83),P0.001],但未降低其住院风险[RR=0.98,95%CI(0.83,1.14),P=0.77]。亚组分析结果显示:①流感疫苗接种降低心力衰竭患者流感季、非流感季、1年随访期间和长期随访期间(最长4年)全因死亡风险[RR流=0.52,95%CI(0.39,0.69),P0.001;RR非流=0.80,95%CI(0.70,0.90),P0.001;RR1年=0.76,95%CI(0.63,0.92),P0.001;RR长期=0.82,95%CI(0.81,0.83),P0.001];②流感疫苗接种降低心力衰竭患者流感季心血管(CV)住院风险[RR=0.84,95%CI(0.76,0.93),P0.001],但未降低非流感季CV住院和长期随访期间(中位随访时间27个月)全因住院风险[RR非流=1.04,95%CI(0.91,1.19),P=0.56;RR长期=1.07,95%CI(0.97,1.18),P=0.17]。结论:流感疫苗接种可降低心力衰竭患者不同季节全因死亡风险和流感季CV住院风险。     

脑钠肽和心肌收缩力储备在评估慢性心力衰竭长期预后中价值的研究

目的探讨脑钠肽(BNP)和心肌收缩力储备(MCR)在评估慢性心力衰竭(CHF)长期预后中的价值。方法将64例合乎研究条件的患者进行血浆BNP浓度、MCR、静息左室射血分数(LVEF)的检测及NYHA心功能评估;根据上述参数的中位数进行分组,每2个月随访患者1次,观察终点为心源性死亡,随访期为54个月。结果随访期末,数据显示BNP与MCR和心源性死亡的关系紧密(r分别为0.421和-0.443;P分别为0.001和0.000);而静息LVEF和NYHA心功能与死亡没有相关性(r分别为-0.057和0.110;P分别为0.652和0.384)。高于BNP中位数组的死亡例数比低于BNP中位数组的死亡例数明显多(11/22和8/41,P=0.020),两组死亡相对危险比为2.56(95%CI);相反,高于MCR中位数组的死亡例数比低于MCR中位数组的死亡例数明显少(4/30和14/26,P=0.002),死亡相对危险比为1.88(95%CI);两者之间BNP的死亡危险比高于MCR。高于静息LVEF中位数组的死亡例数和低于静息LVEF中位数组的死亡例数差别很小(11/38和8/27,P=1.000),死亡相对危险比为1.01(95%CI);同样,高于NYHA心功能分级中位数组的死亡例数和低于NYHA心功能分级中位数组的死亡例数差别也很小(3/15和13/45,P=0.738),死亡相对危险比为1.13(95%CI)。还可以看到A组(MCR<24,BNP>189)和B组(MCR>24,BNP<189)之间死亡相对危险比竟高达12.8(95%CI)。结论BNP和MCR在评价CHF长期预后中具有重要意义,其中BNP甚至优于MCR;如果联合使用MCR和BNP可以更有力预示CHF的远期死亡;而静息LVEF和NYHA心功能分级与CHF的长期预后无关,不能够用来评估CHF的长期预后。容易获取又完全客观的BNP应该成为CHF患者常规检查;有条件的医院应该把MCR检测作为评估CHF远期预后的重要手段。     

不同肾功能评价指标对慢性心力衰竭患者远期预后的预测价值

目的比较不同肾功能评价指标在慢性心力衰竭(CHF)患者远期生存中的预测价值。方法选取2006年1月至2014年8月于中国中医科学院广安门医院心内科住院的CHF患者546例为研究对象,随访周期为730 d,终点事件为全因死亡。根据是否发生终点事件将546例患者分为两组:非终点事件组337例(69.0%)和终点事件组169例(31.0%)。采用受试者工作曲线(ROC)评价估算的肾小球滤过率(eGFR)、血肌酐(SCr)和血尿素氮(BUN)对CHF全因死亡的预测能力;选择各指标的最佳切点值进行分组,以Kaplan-Meier生存曲线描述各组生存率;采用多因素Cox回归模型分析不同肾功能指标与远期预后的相关性。结果共纳入CHF患者546例,其中资料完整者392例,未完成随访者154例。eGFR、SCr和BUN的ROC曲线下面积分别为0.631、0.633和0.706,最佳切点值分别为58.61 ml/(min·1.73 m2)、113.75μmol/L和7.41 mmol/L。Kaplan-Meier生存曲线显示,eGFR降低组、SCr升高组和BUN升高组患者全因死亡风险更高(P0.001)。校正年龄、性别、心功能等因素后,BUN是CHF全因死亡的独立危险因素(HR=1.043,95%CI:1.007～1.082,P0.001)。结论 eGFR、SCr和BUN对CHF远期预后具有预测价值,其中BUN是CHF全因死亡的独立危险因素。     

心力衰竭患者的蛋白尿和B型钠尿肽对主要不良心脏事件的影响

目的评价慢性心力衰竭(CHF)患者蛋白尿和B型钠尿肽(BNP)对主要不良心血管事件(MACE)的影响。方法选择382例CHF患者,分为无蛋白尿组231例和蛋白尿组151例。根据入院24h内试纸条法检测的蛋白尿结果判断蛋白尿,并分轻度和重度,免疫荧光法测定BNP。结果蛋白尿组与无蛋白尿组BNP比较有显著差异[(954.0±367.0)ng/L vs(865.0±401.0)ng/L,P=0.029]。蛋白尿组合并糖尿病及冠心病的比例较无蛋白尿组高(P<0.01),心功能分级(NYHA)更高(P=0.04)。蛋白尿组MACE发生率显著高于无蛋白尿组(19.21%vs6.93%,P<0.01)。多因素logistic回归模型中,经年龄、合并症、BNP、血红蛋白和估计肾小球滤过率校正后,蛋白尿仍然是心源性休克(OR=1.98,95%CI:1.21~2.39,P<0.01)及院内死亡(OR=2.56,95%CI:1.65~3.95,P<0.01)的独立危险因素。与无蛋白尿组比较,蛋白尿组增加MACE中的心源性休克(OR=1.88,P=0.020)和院内死亡(OR=2.40,P=0.004)的风险。结论 CHF患者的蛋白尿与BNP相关,可能是预测发生MACE的危险因素。     

脑钠肽基线水平对慢性心力衰竭患者远期预后的预测价值

目的:探讨脑钠肽(BNP)基线水平对慢性心力衰竭(CHF)患者远期预后的预测价值。方法:选取我院2010-01-2012-01住院的120例CHF患者作为研究对象,按照BNP基线水平将其分为低水平组、中等水平组和高水平组。比较3组患者BNP基线水平与心功能、左心室射血分数(LVEF)的关系,并根据随访结果分析BNP基线水平对患者终点事件(全因死亡率、心血管死亡率、首次心血管疾病再住院率以及首次心力衰竭再住院率)的预测作用。结果:BNP高水平组NYHAⅢ~Ⅳ级患者数增加,LVEF水平降低;BNP基线水平处于高水平的患者远期全因死亡率、心血管死亡率以及首次-心力衰竭再住院率均明显升高。结论:CHF患者BNP基线水平不仅能够反映患者近期的心功能状态,还可以对其远期预后进行预测评估。     

Intravenous iron alone for the treatment of anemia in patients with chronic heart failure.

OBJECTIVES: This study was undertaken to assess the hematologic, clinical, and biochemical response to intravenous iron in patients with chronic heart failure (CHF) and anemia. BACKGROUND: Anemia is common in patients with CHF and is associated with higher morbidity and mortality. The combination of erythropoietin (EPO) and iron increases hemoglobin (Hb) and improves symptoms and exercise capacity in anemic CHF patients. It is not known whether intravenous iron alone is an effective treatment for anemia associated with CHF. METHODS: Sixteen anemic patients (Hb < or =12 g/dl) with stable CHF (age 68.3 +/- 11.5 years, 12 men, 9 participants New York Heart Association [NYHA] functional class II and the remainder class III, left ventricular ejection fraction 26 +/- 13%) received a maximum of 1 g of iron sucrose by bolus intravenous injections over a 12-day treatment phase in an outpatient setting. Mean follow-up was 92 +/- 6 days. RESULTS: Hemoglobin rose from 11.2 +/- 0.7 to 12.6 +/- 1.2 g/dl (p = 0.0007), Minnesota Living with Heart Failure (MLHF) score fell (denoting improvement) from 33 +/- 19 to 19 +/- 14 (p = 0.02), 6-min walk distance increased from 242 +/- 78 m to 286 +/- 72 m (p = 0.01), and all patients recorded NYHA class II at study end (p < 0.02). Changes in MLHF score and 6-min walk distance related closely to changes in Hb (r = 0.76, p = 0.002; r = 0.56, p = 0.03, respectively). Of all baseline measurements, only iron and transferrin saturation correlated with increases in Hb (r = 0.60, p = 0.02; r = 0.60, p = 0.01, respectively). There were no adverse events relating to drug administration or during follow-up. CONCLUSIONS: Intravenous iron sucrose, when used without concomitant EPO, is a simple and safe therapy that increases Hb, reduces symptoms, and improves exercise capacity in anemic patients with CHF. Further assessment of its efficacy should be made in a multicenter, randomized, placebo-controlled trial.     

Prognostic value of plasma erythropoietin on mortality in patients with chronic heart failure

OBJECTIVES: This study aimed to investigate the prognostic importance of plasma erythropoietin (EPO) levels in chronic heart failure (CHF) patients. BACKGROUND: Anemia is common and is associated with an impaired survival in patients with CHF. Erythropoietin is a hematopoietic growth factor, upregulated in anemic conditions. Little is known about the pathophysiology of anemia in CHF and the prognostic importance of plasma EPO levels in CHF patients. METHODS: In 74 patients with CHF (age, 61 +/- 2 years; left ventricular ejection fraction, 0.31 +/- 0.01; peak oxygen consumption, 19.1 +/- 0.6 [mean +/- SEM]) and in 15 control patients, hemoglobin levels and plasma concentrations of EPO and brain natriuretic peptide were measured. RESULTS: During a mean follow-up of 3.0 years (range, 2.3 to 5.3 years), 22 patients (30%) died. Anemia was present in 24% of the patients. Multivariate analysis showed that plasma EPO (p = 0.026) and hemoglobin levels (p = 0.005) were independent predictors of survival in this CHF population. We observed only a mild inverse correlation between the logarithm of EPO and hemoglobin levels (r2 = 0.08, p = 0.02) in CHF patients, whereas the control group showed a clear significant inverse correlation (r2 = 0.44, p = 0.007). CONCLUSIONS: Elevated plasma EPO levels are associated with an impaired prognosis independent of hemoglobin levels and other established markers of CHF severity. Furthermore, in the CHF patients, EPO levels poorly correlate with the hemoglobin levels, in contrast with the control group.     

Prognostic importance of plasma NT-pro BNP in chronic heart failure in patients treated with a beta-blocker: results from the Carvedilol Or Metoprolol European Trial (COMET) trial

BACKGROUND: Plasma levels of N-terminal pro-brain natriuretic peptide (NT-pro BNP) are increased in patients with chronic heart failure (CHF). Beta-blockers (BB) may influence these levels but it is unclear whether changes in NT-pro BNP reflect concomitant changes in prognosis. OBJECTIVES: To assess the prognostic importance of NT-pro BNP at baseline and during follow-up, in patients in whom beta-blocker therapy is initiated. METHODS: In COMET, 3029 patients with CHF in NYHA class II-IV and EF<35% were randomised to carvedilol or metoprolol tartrate and were followed for an average of 58 months. Blood samples were collected for the measurement of NT-pro BNP at baseline (n=1559) and during follow-up (n=309). RESULTS: Baseline plasma concentrations of NT-pro BNP above the median (1242 pg/ml) were associated with higher all-cause mortality (RR 2.77; 95% CI 2.33-3.3, p<0.001). Patients who achieved NT-pro BNP levels<400 pg/ml during follow-up had a lower subsequent mortality (RR 0.32; 95% CI 0.15-0.69, p=0.004). CONCLUSIONS: The plasma concentration of NT-pro BNP is a powerful predictor of mortality in patients with CHF. Patients who achieve an NT-pro BNP of <400 pg/ml subsequent to treatment with a beta-blocker have a favourable prognosis.     

Anemia in patients with heart failure: prevalence and prognostic role in a controlled trial and in clinical practice

BACKGROUND: Aims of the present study were (1) to confirm the prognostic role of anemia in patients with heart failure (HF) and (2) to analyze this aspect in relatively unselected patients with HF monitored prospectively in a community setting (IN-CHF), and in patients selected for enrollment into the Valsartan Heart Failure Trial (Val-HeFT). METHODS AND RESULTS: In both Val-HeFT and IN-CHF Registry, anemia was defined as a hemoglobin (Hb) level < or = 11 g/dL in women and < or = 12 g/dL in men. Of the 2411 patients of the IN-CHF Registry, 15.5% had anemia, whereas in the 5010 patients of the Val-HeFT trial, the prevalence was 9.9%. In the IN-CHF registry, 1-year all-cause mortality was significantly higher in anemic patients (25.9%) than in patients without anemia (13.2%) (P < .0001). The association of anemia with mortality was confirmed by the multivariable analysis (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.20-1.97). The risk of death decreased by 9.7% for each gram of Hb. The Val-HeFT trial showed an all-cause mortality rate for anemic patients of 29.6% over a mean follow-up period of 22.4 months versus 18.5% (P < .0001) in patients without anemia. After adjustment, anemia retained its negative independent prognostic role (HR 1.26, 95% CI 1.04-1.52). When Hb was considered as a continuous variable, the risk of death decreased by 7.8% for each gram of Hb. CONCLUSIONS: Anemia was confirmed to be an independent negative prognostic factor in patients with HF. This finding is consistent in 2 different clinical contexts, a controlled trial and a registry in clinical practice, in which patient characteristics and outcome are largely different.     

The synergistic combined effect of anemia with high plasma levels of B-type natriuretic peptide significantly predicts an enhanced risk for major adverse cardiac events

The prevalence of anemia in patients with heart failure (HF) increases according to disease severity as a consequence of renal insufficiency, cytokine production, plasma volume expansion, and/or malnutrition. B-type natriuretic peptide (BNP) has been recognized as a biochemical marker of ventricular dysfunction. The aim of this study was to evaluate the clinical significance of anemia in HF patients and furthermore, to investigate whether a significant correlation exists between anemia, BNP, and poor clinical outcomes in HF patients. We studied 185 consecutive HF patients. We assessed the occurrence of major adverse cardiac events (MACE) post hospital discharge. Anemia was defined as Hb concentrations <12.9 g/dl in men and <11.3 g/dl in women, respectively. Kaplan-Meier analysis revealed that anemia and high BNP levels (>259 pg/ml) were significantly associated with the occurrence of MACE. Multiple logistic analysis revealed that the most predictive independent risk factor for the occurrence of MACE was high BNP levels, followed by anemia (relative risk [RR] = 2.803 and 2.241, respectively). We divided the patients with or without anemia and high or low BNP levels into four groups according to their respective Hb and BNP levels. The hazard ratio for MACE in the group with anemia and high BNP levels was 10.3 in comparison to the group without anemia and with low BNP levels (P = 0.0002). Both anemia and high plasma levels of BNP are significantly and independently associated with the occurrence of MACE in HF patients; furthermore, the synergistic effect of anemia combined with high BNP levels significantly predicts an enhanced risk for MACE.     

托拉塞米与呋塞米治疗慢性心衰的疗效和安全性Meta分析

目的：评价托拉塞米治疗慢性心力衰竭的有效性及安全性。方法计算机检索1989年至2013年5月Cochrane图书馆临床对照试验资料库、PubMed、Embase收集托拉塞米治疗慢性心力衰竭的随机对照试验,按纳入和排除标准提取资料,交叉核对并进行方法学质量评估,使用RevMan 5.1软件进行Meta分析。结果共纳入9项研究,2099例患者。Meta分析显示：①托拉塞米在改善NYHA心功能分级方面明显优于呋塞米（WMD=-0.13,95％CI：-0.19~-0.07,P＜0.0001）;②托拉塞米在改善患者左室射血分数（LVEF）方面作用同呋塞米相当[WMD=0.16,95％CI：-0.08~-0.40,P=0.19];③托拉塞米在改善患者左心室质量指数（LVMI）（WMD=-7.40,95％CI：-12.02~-2.77,P=0.002）和B型脑钠肽BNP （WMD=-59.86,95％CI：-94.82~24.89,P=0.0008）方面优于呋塞米;④托拉塞米同呋塞米相比不增加任何与药物相关的副作用（RR=1.25,95％CI：0.68~2.32,P=0.47）和全因死亡率（RR=0.87,95％CI：0.54~1.41,P=0.57）。结论托拉塞米同呋塞米一样对慢性心力衰竭患者是有效的、安全的,托拉塞米在改善患者心衰症状、降低LVMI和BNP方面似乎优于呋塞米,但其需要更多数据进一步对其评价。     

Prevalence of anemia in patients admitted to hospital with a primary diagnosis of congestive heart failure

OBJECTIVES: To find the prevalence of anemia in patients hospitalized with the primary diagnosis of congestive heart failure (CHF). BACKGROUND: There is growing evidence that anemia is common in CHF and may contribute to the high morbidity and mortality associated with this condition. However, there is considerable disagreement about the prevalence of anemia in this condition. METHODS: In 338 consecutive patients who were admitted to the medical wards with a primary diagnosis of CHF we extracted from the charts the hemoglobin (Hb), serum creatinine, age, sex, New York Heart Association (NYHA) functional class, presence of smoking, diabetes, hypertension, hyperlipidemia and the primary cardiac etiology of the CHF. Anemia was considered to be present when the Hb on admission was <12 g/dl. RESULTS: All the patients were NYHA functional class III-IV. One hundred seventy seven (52.4%) of the 338 patients had a Hb on admission that was <12 g/dl. The mean Hb for the entire group was 12.0+/-1.8 g/dl. One hundred three (51.0%) of the 202 males were anemic compared to 74 (54.4%) of the 136 women. The mean serum creatinine was 1.7+/-1.1 mg/dl. The prevalence of renal insufficiency (serum creatinine >1.5 mg%) was 47.6%. There was a negative correlation between the level of serum creatinine and Hb (r=-0.294) P<0.00001. Of the 177 patients who were anemic, most of 114 (64.4%) had a serum creatinine >1.5 mg/dl. CONCLUSIONS: Anemia is a common finding in patients hospitalized with CHF and most anemic CHF patients have some degree of renal insufficiency. In view of the negative effect of anemia on cardiac function, it may be a common and important contributor to the mortality and morbidity of CHF in these patients.     

The effect of correction of mild anemia in severe, resistant congestive heart failure using subcutaneous erythropoietin and intravenous iron: a randomized controlled study

OBJECTIVES: This is a randomized controlled study of anemic patients with severe congestive heart failure (CHF) to assess the effect of correction of the anemia on cardiac and renal function and hospitalization. BACKGROUND: Although mild anemia occurs frequently in patients with CHF, there is very little information about the effect of correcting it with erythropoietin (EPO) and intravenous iron. METHODS: Thirty-two patients with moderate to severe CHF (New York Heart Association [NYHA] class III to IV) who had a left ventricular ejection fraction (LVEF) of < or =40% despite maximally tolerated doses of CHF medications and whose hemoglobin (Hb) levels were persistently between 10.0 and 11.5 g% were randomized into two groups. Group A (16 patients) received subcutaneous EPO and IV iron to increase the level of Hb to at least 12.5 g%. In Group B (16 patients) the anemia was not treated. The doses of all the CHF medications were maintained at the maximally tolerated levels except for oral and intravenous (IV) furosemide, whose doses were increased or decreased according to the clinical need. RESULTS: Over a mean of 8.2+/-2.6 months, four patients in Group B and none in Group A died of CHF-related illnesses. The mean NYHA class improved by 42.1% in A and worsened by 11.4% in B. The LVEF increased by 5.5% in A and decreased by 5.4% in B. The serum creatinine did not change in A and increased by 28.6% in B. The need for oral and IV furosemide decreased by 51.3% and 91.3% respectively in A and increased by 28.5% and 28.0% respectively in B. The number of days spent in hospital compared with the same period of time before entering the study decreased by 79.0% in A and increased by 57.6% in B. CONCLUSIONS: When anemia in CHF is treated with EPO and IV iron, a marked improvement in cardiac and patient function is seen, associated with less hospitalization and renal impairment and less need for diuretics.     

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。