老年慢性心力衰竭患者贫血与心功能关系的探讨

Relationship between hemoglobin concentration and cardiac function in patients with congestive heart failure

目的研究老年慢性心力衰竭(CHF)患者中血红蛋白(Hb)水平变化与心功能的关系。方法对入选的286例年龄>60岁的CHF患者(CHF组)行临床、实验室和超声心动图检查,并进行心功能分级(NYHA);CHF组患者按Hb水平又分为贫血组(136例)和非贫血组(150例);根据NYHA分为轻、中度心力衰竭患者(203例),重度心力衰竭患者(83例);同时选择98例健康体检老年人为对照组,分别比较各组间不同性别血液学参数、血尿素、肌酐(Cr)、LVFF、左心室舒张末期内径(LVEDD)、贫血发生率、病死率,并采用改良简化的MDRD方程计算肾小球滤过率(GFR)。结果与对照组比较,CHF组男、女性患者的Hb、红细胞比容、LVEF和GFR均明显降低(P<0.01),尿素、Cr和LVEDD均明显升高(P<0.05,P<0.01);与轻、中度心力衰竭患者比较,重度心力衰竭患者Hb、红细胞比容、LVEF和GFR均明显降低,Cr、LVEDD、贫血发生率、病死率逐步升高(P<0.05,P<0.01)。CHF患者的Hb、LVEF均与Cr呈负相关,而与GFR呈正相关(P<0.01),Hb与LVEF呈正相关(P<0.01)。结论老年CHF男、女性患者常伴有贫血和肾功能损害,贫血和肾功能损害的程度均与CHF的严重程度呈正相关,贫血、肾功能损害均使CHF患者死亡危险性增高。

Objective To study possible association between hemoglobin level and NYHA-class in different genders of aged patients with chronic cardiac failure. Methods 286 inpatients with chronic cardiac failure were selected in the study. The patients were classified with NYHA-class,and were divided into anemia group and non-anemia group according to hemoglobin level. Ninety-eight healthy old persons were selected as control group. Data such as left ventricular ejection fraction （LVEF）, left ventricular end diastolic diameter （LVEDD）, hematologic parameters, anemia inci- dence, case fatality, blood urea nitrogen（BUN）,creatinine, blood uric acid were collected and com- pared between 2 groups. Results Compared with control group,the level of hemoglobin,haematocrit, glomerular filtration rate（GFR） and LVEF were decreased （P 〈 0.01）, and the level of creatinine,BUN and LVEDD were increased in CHF group. Compared with patients with mild heart failure, hemoglobin, hematocrit, LVEF and GFR were significantly decreased, and creatinine, LVEDD,anemia incidence and case fatality were increased gradually in severe heart failure patients （P 〈 0.01）. Hemoglobin and LVEF were negatively correlated with creatinine and positively correlated with GFR in aged patients with chronic cardiac failure （P〈 0.01）. Hemoglobin was positively correlated with LVEF （P 〈 0. 01）. Compared with non-anemia group, anemia group had higher fatality rate （P 〈 0.01）. Conclusion The aged patients with chronic cardiac failure often have anemia and renal functional impairment,and the degrees of both of them have positive correlation with the degree of congestive heart failure in both females and males of China. Both of them can increase the risk of death in aged patients with chronic cardiac failure.