慢性心力衰竭患者血红蛋白水平与心肾功能的相关性

目的:探讨慢性心力衰竭(CHF)患者血红蛋白(Hb)水平与其心功能、肾功能的关系。方法:150例CHF男性患者按照心功能分为三组:NYHA II级组44例、III级组49例,IV级组57例,并随机抽选30例健康体检患者为健康对照组,分析各组心功能指标[左室舒张末期内径(LVEDd),左室射血分数(LVEF),N末端脑利钠肽前体(NT-proBNP)],肾功能指标[血清肌酐(SCr),肾小球率过滤(GFR)],血液学指标[Hb,红细胞(RBC),血红细胞比容(HCT)];根据CHF患者贫血情况分为贫血组(61例)和非贫血组(89例),并对两组上述指标进行比较。结果:CHF各组贫血发生率均明显高于健康对照组,且随着心衰等级的增加而明显升高(P<0.05);与健康对照组比较,CHF各组心功能各项指标(LVEDd,LVEF,NT-proBNP),肾功能指标(SCr,GFR),血液学指标(Hb,RBC,HCT)均有明显恶化,且随着心衰等级增加而明显加重(P均<0.05);与CHF非贫血组比较,CHF贫血组SCr[(89.78±44.79)mmol/L比(78.79±45.02)mmol/L]、GFR[(86.13±25.42)ml.min-1(1.73m)-1比(67.99±32.12)ml.min-1(1.73m)-1]、LVEF[(55.79±11.34)%比(45.65±12.03)%]水平明显降低,LVEDd[(49.89±8.93)mm比(56.45±11.23)mm]明显增大,NT-proBNP[(945.27±1249.76)pg/ml比(3884.23±2790.42)pg/ml]水平明显升高(P<0.05);线性相关分析显示Hb与LVEDd、NT-proBNP呈负相关(r=-0.346,-0.547,P均<0.05),与LVEF、GFR呈正相关(r=0.453,0.338;P均<0.05)。结论:慢性心力衰竭患者血红蛋白下降会显著降低心、肾功能。

Relationship among hemoglobin level and cardiac function,renal function in patients with chronic heart failure

Objective：To explore the relationship among hemoglobin（Hb） level and cardiac function,renal function in patients with chronic heart failure（CHF）.Methods：According to NYHA cardiac function class,a total of 150 male CHF patients were divided into NYHA class II group（n=44）,NYHA class III group（n=49） and NYHA class IV group（n=57）.Another 30healthy subjects were randomly selected as healthy control group.Indexes of cardiac function [ left ventricular end-diastolic dimension（LVEDd）,left ventricular ejection fraction（LVEF）,N terminal pro brain natriuretic peptide（NT-proBNP）],of renal function [ serum creatinine（SCr）,glomerular filtration rate（GFR）] and hematological indexes [ Hb,red blood cells（RBC）,hematocrit（HCT）] were examined in all groups.According to anemia condition of CHF patients,they were divided into CHF anemia group（n=61） and CHF nonanemia group（n=89）,and above indexes were compared between two groups.Results：Incidence rates of anemia in all CHF groups were significantly higher than that of healthy control group,and it significantly increased along with NYHA class increased（P〈0.05）;compared with healthy control group,there were significant aggravation in indexes of cardiac function（LVEDd,LVEF,NT-proBNP）,indexes of renal function（SCr,GFR） and hematological indexes（Hb,RBC,HCT） in all CHF groups,and they significantly aggravated along with NYHA class increased（P〈0.05all）;compared with CHF non-anemia group,there were significant decrease in levels of SCr [（89.78±44.79） mmol/L vs.（78.79±45.02） mmol/L ],GFR [（86.13±25.42） ml.min^-1（1.73m）^-1 vs.（67.99±32.12） ml.min^-1（1.73m）^-1 ] and LVEF [（55.79±11.34） % vs.（45.65±12.03） % ],and significant increase in LVEDd [（49.89±8.93） mm vs.（56.45±11.23） mm ] and NT-proBNP level [（945.27±1249.76） pg/ml vs.（3884.23±2790.42） pg/ml ] in CHF anemia group,P〈0.05all;Linear correlation analysis indicated that Hb was negatively correlated with LVEDd and NT-proBNP（r=-0.346,-0.547,P〈0.05both）,and positively correlated with LVEF and GFR（r=0.453,0.338,P〈0.05both）.Conclusion：Hemoglobin level descent may significantly reduce cardiac and renal function in patients with chronic heart failure complicated anemia.