促红细胞生成素对老年心力衰竭合并贫血患者肾功能及N末端前脑钠肽的影响

Effects of erythropoietin on renal function and level of N-terminal pro-B-type natriuretic peptide in old patients with chronic heart failure and anemia

目的观察促红细胞生成素(EPO)联合口服铁剂治疗对老年慢性心力衰竭(CHF)合并贫血患者血红蛋白、心功能、肾功能参数的影响。方法将87例心功能Ⅱ～Ⅳ级(NYHA)的老年CHF合并贫血(Hb<110g/L)患者随机分至治疗组(n=44例)及对照组(n=43例)。在CHF常规治疗基础上,对照组给予口服铁剂,治疗组给予口服铁剂+皮下注射EPO。治疗4周后,观察两组血红蛋白、血肌酐、肌酐清除率、心功能、N末端前脑钠肽(NT- ProBNP)变化。结果(1)与治疗前相比,治疗后治疗组Hb明显升高[(112.1±3.4)g/L vs(98.3±5.4)g/L,P<0.01],血清肌酐水平明显降低[(162.1±39.3)μmol/L vs(185.0±31.2)μmol/L,P<0.05],肌酐清除率增加[(43.5±7.1)ml/min vs(38.2±9.0)ml/min,P<0.05],NYHA心功能分级明显改善(2.5±0.5 vs 3.2±0.7,P<0.01),血浆NT-Pro BNP显著下降[(1636.3±436.7)ng/L vs(2217.8±960.2)ng/L,P<0.05]。对照组,上述参数均有所改善,但差异无显著性;(2)与对照组相比,治疗后治疗组Hb高于对照组,血清肌酐水平低于对照组,肌酐清除率高于对照组,NYHA心功能分级级别低于对照组,血浆NT-Pro BNP低于对照组。结论在CHF合并贫血的老年患者中应用EPO和口服铁剂治疗,在纠正贫血基础上,可以进一步改善心功能(NYHA分级)、肾功能并降低血浆NT-ProBNP水平。

Objective To investigate the effects of erythropoietin（EPO） and oral iron preparation on hemoglo- bin（Hb）, cardiac and renal functions of old patients with congestive heart （ailure（CHF） and anemia. Methods Eighty-seven patients with CHF （NYHA Ⅱ～Ⅳ）and anemia （Hb〈110g/L）were randomized to treatment group （n= 44） and control group（n= 43）. All patients received the standard treatment of heart failure. Patients in treatment group received sc EPO 4000U twice weekly and oral iron preparation daily for 4 weeks. The patients in control group only received oral iron preparation. After four-week treatment, the levels of Hb, serum creatinine, creatinine clearance, plasma NT-ProBNP and cardiac function were examined. Results In treatment group, there were significant increase in Hb 〈 （112. 1±3. 4）g/L vs （98. 3 ± 5. 4） g/L, P〈 0. 01], significant reduction in serum creatinine 〈（162.1±39.3）μmol/L vs （185.0±31.2）/lmol/L,P〈0.05], increase in creatinine clearance 〈（ 43. 5±7. 1）ml/min vs （38. 2±9.0） ml/min, P 〈0.05], significant improvement in NYHA functional class （2.5±0.5 vs 3.2±0.7,P〈 0.01）and significant fall in plasma NT-ProBNP〈（ 1636.3±436.7）ng/L vs （2217.8±960. 2） ng/L, P 〈0.05], after treatment as compared with those before treatment. In control group, there was no significant change in any of the above parameters. Compared with the patients in control group, the Hb level was higher, the level of serum creatinine was lower, creatinine clearance was higher, NYHA functional class was better and the concentration of plasma NT-ProBNP was lower in treatment group after treatment. Conclusion The treatment with EPO and oral iron preparation can not only increase the level of Hb, but also improve the cardiac and renal functions and reduce the level of plasma NT-ProBNP in old patients with anemia and CHF.