促红细胞生长素对充血性心衰患者心功能的影响

Effects of Erythropoietin Treatment on Cardiac Function in Patients with Congestive Heart Failure

目的探讨充血性心衰(CHF)并贫血的患者,在EPO加铁剂治疗后,对心脏结构与功能及B型利钠肽水平的影响。方法32例连续CHF并贫血(80g/L<血红蛋白<120g/L)的患者纳入本研究。以随机方法分为治疗组(A组、16例),皮下注射EPO12000IU/周+每天口服铁剂共4个月。对照组(B组、16例),每天口服铁剂。结果A组患者在随机治疗的4个月中,相对于基础状态血红蛋白增加(P<0.001),左室内径缩小(P<0.001),射血分数增加(P<0.05),心功能分级(P<0.001)与6min步行试验(P<0.05)改善,同时血浆中B型利钠肽水平(P<0.01)下降。B组患者在试验期间射血分数(P<0.05)及6min步行距离(P<0.05)有所下降,其他指标无明显变化。结论CHF并贫血患者,EPO加口服铁剂治疗,能改善患者的心脏结构与功能,降低B型利钠肽水平。

Objective To study the effects of erythropoietin （ EPO ） plus oral iron on cardiac construction, function and B-natriuretic peptide （BNP） level in patients with congestive heart failure （CHF） and anemia. Methods Thirty-two consecutive subjects with CHF and anemia were enrolled into the study. They were randomized into trial group （Group A, n = 16） and control group （ Group B, n = 16）. Group A was administered hypodermal EPO for four months （ 12,000 iu/week） in addition to daily oral iron, and meanwhile Group B took daily oral iron alone. Results With respect to the baseline, the patients in Group A demonstrated an increase in hemoglobin （P 〈 0. 001 ）, a reduction in left ventricular diastolic diameter （LVDD） （P 〈 0. 001 ）, an increase in left ventricular ejection fraction （LVEF） （P 〈 0.05 ）, an improvement in new York Heart Association functional class （ P 〈 0. 001 ） and 6 - minute walking testing （ P 〈 0.05 ） and a decrease in plasma BNP level （ P 〈 0.01 ） ; and those in Group B showed a fall in LVEF （ P 〈 0.05 ） and in distance of 6 - minute walking testing （ P 〈 0.05 ） , and showed no differences in other indexes. Conclu＇ sion In anemic CHF patients, correction of anemia with EPO and iron leads to improvements in cardiac construction and function, and a fall in plasma BNP level.