急性心肌梗死患者贫血与促红细胞生成素水平和肾功能的关系

Relationship among anemia,erythropoietin level and renal function in acute myocardial infarction patients

目的研究急性心肌梗死(AMI)患者贫血的患病情况及贫血与促红细胞生成素(EPO)和肾功能的关系。方法对72例AMI患者和44例健康对照者进行血红蛋白(Hb)、血EPO和尿白蛋白与尿肌酐比值(ACR)测定。采用简化MDRD公式计算肾小球滤过率(GFR)。结果AMI患者中贫血(女性Hb<110 g/L;男性Hb<120 g/L)患病率为44.4%,显著高于对照组(P<0.001)。AMI患者中,贫血多见于女性、低体质指数、合并高血压、糖尿病和心、肾功能不全的患者。贫血组EPO水平较非贫血组显著升高[(25.12±2.19)U/Lvs.(15.84±1.91)U/L,P<0.05],但实测与预计lgEPO(O/P)比值两组差异无统计学意义。对于AMI患者,Hb水平还与Killip评分(r=-0.447,P<0.001)、血Cr(r=-0.448,P<0.01)、GFR(r=0.603,P<0.001)和lgACR(r=-0.502,P<0.01)相关。结论AMI患者常伴有贫血,血红蛋白可作为反映AMI患者病情严重程度的指标。肾功能受损可加重贫血的发生,而EPO降低不是AMI患者贫血发病的主要原因。

Objective To investigate the prevalence of anemia and the relationship among anemia, erythropoietin （EPO） and renal function in acute myocardial infarction （AMI） patients. Methods Hemoglobin （Hb） level, plasma EPO level and urine Albumin/creatinine ratio （ACR） were determined and glomerular filtration rate （GFR） was estimated by simplified Modification of Diet in Renal Disease （MDRD）equation in 72 AMI patients and in 44 controls which had no heart diseases. Results The prevalence of anemia in AMI patients was significantly higher than in controls （44.4% vs. 13.6%, P〈0. 001）. Anemia was more common in female, small body mass index, pre-existing diabetes mellitus, hypertension heart and renal failure AMI patients. EPO levels were significantly higher in anemic subjects than in non-anemic subjects [（25.12±2.19） U/L vs. （15.84±1.91） U/L, P〈0.05], while the difference of observed/predicted lgEPO （O/P） ratio between these two groups was not significant. Correlation was observed between Hb and Killip class （r=-0. 447,P〈0. 001）, serum Creatine （r=-0. 448,P〈 0.01）, GFR （r=0. 603,P〈0. 001） and IgACR （r=--0. 502,P〈0.01）. Conclusions Anemia is common in AMI patients, hemoglobin level could be considered on as a severity index of AML Renal disfunction can aggravate anemia, but the reduced EPO level is not a main cause of anemia in AMI patients.