内源性促红细胞生成素对慢性心力衰竭患者预后的影响

Influence of endogenous erythropoietin levels on prognosis of patients with chronic heart failure

目的了解内源性促红细胞生成素(EPO)对慢性心力衰竭(CHF)患者预后的判定价值。方法选择住院的CHF患者115例,以患者是否存活分为死亡组55例,存活组60例。另选同期住院的年龄、性别相匹配的非CHF患者67例为对照组,以便建立logEPO和血红蛋白(Hb)的回归方程。对CHF患者进行全因死亡和因心力衰竭再次入院的随访观察,测定血EPO,并进行分析。结果与存活组比较,死亡组高龄患者多、心功能(NYHA)Ⅱ级比例低、Hb降低和B型钠尿肽(BNP)水平升高(P<0.01)。Kaplan-Meier生存曲线显示,贫血的CHF患者病死率增高(RR=2.50,95%CI:1.38～4.54,P=0.002)。ROC曲线评估EPO和BNP预测CHF患者死亡的最佳界值分别为44.4 U/L和752 ug/L(P=0.036,=0.000)。年龄、Hb、BNP和NYHA对CHF患者全因死亡有独立预测价值;而男性、BNP和Hb水平对因心力衰竭再次入院有独立预测价值。贫血的CHF患者EPO是独立于Hb的全因死亡的强预测指标(RR=2.86,95%CI:1.18～6.94,P=0.020)。结论贫血是CHF患者不良预后的独立预测因素。EPO是贫血CHF患者全因死亡的独立预测指标。

Objective To study the prognostic value of endogenous erythropoietin（EPO） levels in patients with chronic heart failure（CHF）. Methods In 115 inpatients with CHF,plasma concentrations of EPO were determined. The patients were followed up for any length of hospital stay due to heart failure or until all-cause death. Results Median endogenous EPO level was 24.2 U/L in CHF patients. Fifty-five patients（47. 8%） died. Non-survivors had significantly higher age, lower hemoglobin（Hb）, higher NYHA classes and higher brain natriuretic peptide（BNP） levels than survivors. The Kaplan-Meier survival curve clearly demonstrated increased mortality in CHF patients with anemia, （RR =2.50,95% CI： 1.38 4.54, P = 0. 002）. ROC curve analysis also revealed that CHF patients with elevated EPO levels（~44.4 U/L） and elevated BNP levels（≥ 752 μg/L） had significantly increased mortality （P = 0. 036,P = 0. 000）. Cox regression analysis revealed that high age,low Hb,high NYHA classes and high BNP levels were independent predictors of increased mortality risk in CHF patients. Furthermore,male sex,anemia and elevated BNP levels were also found to be independent predictors of CHF rehospitalization. Anemia was present in 66 patients（57.4%）. EPO level was an strong predictor of all-cause death independent of Hb in anemic CHF patients （RR = 2.86,95%CI. 1.18-6.94, P = 0. 020）. Conclusions Anemia was associated with poor prognosis（all cause mortality and CHF hospitalization） in patients with CHF. Endogenous EPO levels were correlated with increased mortality rates in anemic CHF patients.