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

Improvement of left ventricular hypertrophy by anemic-correcting erythropoietin therapy in chronic renal insufficiency

目的 观察早期使用促红细胞生成素治疗贫血对透析前慢性肾衰竭 (CRF)患者心血管病变的影响。方法 采用多中心、前瞻性、对照临床研究。血肌酐 (Scr)在 14 7～ 4 0 0 μmol/L的CRF患者 15 8例 ,按基线Hb水平分组。将Hb <110 g/L的患者分为 2组 ,(1)治疗组 :86例 ,每周接受α 促红细胞生成素 10 0～ 135U/kg皮下注射 ;(2 )对照Ⅰ组 :4 0例 ,未接受α 促红细胞生成素治疗 ;将Hb≥ 110 g/L的 32例患者作为对照Ⅱ组 ,未接受α 促红细胞生成素治疗。行超声心动图检查 ,测左心室质量指数 (LVMI)、血压等 ,随访时间 2年。结果 3组患者基线临床资料 (年龄、性别、原发病、营养状况、高血压的发生率、使用降压药物的种类和数量等 )无明显差异 (均P >0 0 5 ) ;治疗组、对照Ⅰ组、对照Ⅱ组患者左心室肥厚 (LVH)的发生率分别为 72 1%、72 5 %、5 9 4 % ;LVMI与Hb水平呈负相关 (r =- 0 70 ,P <0 0 1) ,与Scr呈正相关 (r =0 6 4 ,P <0 0 5 )。治疗 2 4个月后 ,治疗组患者Hb水平较基线时明显上升 (P <0 0 5 ) ,LVMI较基线时明显下降 (P <0 0 5 ) ,LVH的发生率(5 5 8% )较治疗前降低 16 3% ,但平均动脉压、使用降压药物的数量与基线相比无明显差异。对照Ⅰ组与对照Ⅱ组患者Hb逐渐下降 ,LVMI明显增加 ,LVH?

Objective Left ventricular hypertrophy (LVH) is an independent predictor of morbidity and mortality in dialysis patients. It remains unclear whether efforts to correct anemia in patients with mild to moderate chronic renal insufficiency (CRI) can reverse LVH. This prospective multi center Chinese cohort study evaluates left ventricular mass index (LVMI) evolution in anemic CRI patients with or without recombinant human erythropoietin (rHuEPO) therapy.Methods Six centers enrolled 158 patients with serum creatinine from 147 to 400 μmol/L, and 86 of whom with hemoglobin(Hb)levels < 110 g/L received rHuEPO (Group A). Forty patients with comparable Hb levels (< 110 g/L) but did not receive rHuEPO (Group B) and those with Hb≥110 g/L (Group C, n =32) were served as controls. Echocardiographic studies were performed to evaluate LVMI at baseline and every 3 months during a two year period. Results 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). There was no difference in age, gender, aetiology of renal failure, blood pressure (BP) and cardiovascular risk factors between the 3 groups. The administration of rHuEPO in Group A significantly increased Hb levels from (93 8±14 6)g/L to (111 2±10 3)g/L and decreased LVMI from (142 6±25 7)g/m 2 to (132 4±18 5)g/m 2. The prevalence of LVH decreased 16 3% after a partial correction of anemia at 24 months, whereas Hb levels in controls (Group B and Group C) tended to decrease and LVMI significantly increased compared with baseline. The prevalence of LVH was significantly increased in Group B and C after 24 months. The percentage of patients whose serum creatinine level doubled during the follow up was 3 4% in Group A, 15 0% in Group B and 9 4% in Group C, the difference between Group A and Group B being significant ( P <0 05). In addition, good BP control was obtained without any adverse effects.Conclusion High prevalence of LVH was present in pre dialysis CRI patients, which is associated with severity of anemia. Early treatment of anemia with rHuEPO can reverse LVH in CRI patients.