促红细胞生成素对重症心力衰竭伴贫血患者的疗效分析

Efficacy of erythropoietin in treatment of chronic heart failure patients with anemia

关键词:  慢性心力衰竭  贫血  促红细胞生成素  铁

Key words:  chronic heart failure  anemia  erythropoietin  iron

摘要:

目的 探讨促红细胞生成素(erythropoietin, EPO)对慢性心力衰竭(chronic heart failure, CHF)伴贫血患者的心功能及预后的影响。方法本研究纳入78例中、重度心力衰竭(NYHA Ⅲ～Ⅳ级)伴贫血患者,随机分为:对照组(常规抗心力衰竭治疗)和治疗组(加用EPO和铁剂治疗),共治疗2个月,随访观察12个月。比较2组患者治疗前、治疗4个月后血浆脑钠肽(BNP)水平、心功能分级、左心室的舒张末期内腔直径(LVDd)、左心室的射血分数(LVEF)、血液的血红蛋白表达(Hb)水平、6min步行距离,记录两组无事件生存时间、主要终点事件、次要终点事件等指标。结果 治疗前,两组患者年龄、性别、血压、肌酐、Hb、BNP、伴随疾病、LVEF及NYHA心功能分级等指标差异均无统计学意义(P>0.05)。治疗4个月后,对照组BNP水平、Hb水平、心功能分级、6min步行距离差异均有统计学意义(P<0.05),而LVDd、LVEF差异均无统计学意义(P>0.05)；治疗组BNP水平、心功能分级、LVDd、LVEF、Hb水平、6min步行距离,均有改善,差异均有统计学意义(P<0.05)。两组患者平均无事件生存时间、中位生存时间差异均有统计学意义。1年随访期内的两组患者总体死亡率、心力衰竭死亡率、心肌梗死的发生率、心绞痛发生率及动脉栓塞的发生率方面,差异均无统计学意义(P>0.05)；而两组在1年随访期内心力衰竭恶化住院率差异有统计学意义(P<0.05)。结论 EPO联合铁剂治疗重症CHF伴贫血患者,治疗效果优于单纯常规抗心力衰竭治疗,可有效改善左心室功能,降低心力衰竭恶化入院率。

Abstract:

Objective To assess the efficacy of erythropoietin (EPO) in treatment of chronic heart failure (CHF) patients with anemia. Methods Seventy eight patients with moderate or severe CHF and anemia were randomly assigned in two groups:39 patients in control group received conventional treatment for heart failure only, while 39 patients in study group received additional administration EPO and iron supplement. The plasma brain natriuretic peptide (BNP) levels, cardiac function, LVD, LVEF, hemoglobin (Hb), 6 min walking distance were measured and compared between two groups. The event-free survival time, primary end point, secondary endpoint events were documented in two groups. ResultsThere were no significant differences in age, sex, blood pressure, serum creatinine, Hb, BNP, LVEF and cardiac function before treatment between two groups. BNP levels, cardiac function, Hb level, 6 min walk distance were improved after treatment in both groups (P<0.05); while LVDd and LVEF were improved after treatment only in study group (P<0.05). The event-free survival and median survival time in study group were significantly longer than those in control group (P<0.05). There were no statistically significant in overall mortality, mortality due to heart failure, myocardial infarction, angina, arterial thrombosis incidence after 1 year follow-up, and hospitalization rates due to worsening of heart failure during 1 year follow-up between two groups. Conclusion The treatment of EPO with iron supplement can effectively improve left ventricular function and reduce the hospitalization rate due to worsening heart failure in CHF patients with anemia.