铁缺乏与高龄慢性心衰患者脑钠肽水平的相关性分析

Relationship of iron deficiency and pro-B-type natriuretic peptide in elderly patients of chronic cardiac disfunction

目的心衰患者常存在铁缺乏现象,而并非所有心衰患者都合并贫血,铁缺乏可能是影响心功能的独立危险因素。通过检测高龄心衰患者脑钠肽前体水平及血清铁蛋白和(或)转铁蛋白饱和度水平,在校正影响心功能的其他相关因素后,探讨高龄心衰患者心功能与铁缺乏的相关性。方法采集2011年1月-2013年12月因慢性心衰住院治疗的181例患者,根据血清铁蛋白水平分为铁缺乏组(105例)与铁正常组(76例)。单因素分析比较两组间脑钠肽前体水平、血红蛋白水平、肾小球率过滤、血脂、尿酸等指标,分析铁蛋白水平与脑钠肽前体的相关性。采用偏相关分析校正其他影响脑钠肽前体的因素后,分析铁蛋白水平与脑钠肽前体水平独立相关性。结果铁缺乏组患者脑钠肽前体水平[256.26±393.08)pmol/L]明显高于铁正常组[(152.28±189.90)pmol/L],血红蛋白水平[(111.47±16.43)g/L]明显低于铁正常组[(118.87±19.51)g/L],差异均有统计学意义(P<0.05)。其他指标如肾小球率过滤、尿酸、血脂等,两组组间差异无统计学意义。偏相关分析校正血红蛋白等对脑钠肽的影响,示血清铁蛋白水平和脑钠肽前体水平独立负相关(r=-0.160,P=0.030)。结论高龄心功能不全患者心衰的严重程度(脑钠肽前体水平)与铁缺乏的程度(血清铁蛋白水平)呈独立负相关。

Objective Studies have confirmed that the phenomenon of iron deficiency is common in patients with heart failure and not all patients combined with anemia. Iron deficiency may be the independent risk factor of heart dysfunction. Based on the detec- tion of pro-BNP levels with elderly heart failure patients and serum ferritin and/or transferrin saturation levels, after adjustment for oth- er related influencing factors of cardiac function, to explore the correlation of cardiac function in elderly patients with iron deficiency. Methods 181 patients with chronic heart failure, hospitalized from January 2011 to December 2013, were collected according to the serum ferritin level. These patients were divided into iron deficiency group （105 cases） and normal group （76 cases）. Single factor a- nalysis and comparison of two groups of pro-BNP, hemoglobin levels, rate of glomerular filtration, blood lipid, uric acid were carried out. We confirmed that ferritin level is correlated to pro-BNP. At the same time, the partial correlation analysis after correction for oth- er factors, which affect the pro-BNP, obtain that iron protein levels associated with pro-BNP levels independently. Results pro-BNP （256.26±393.08）pmol/L of iron deficiency group was significantly higher than that in patients in iron normal group （152.28 ± 189. 90）pmol/L. The hemoglobin levels （111.47 ± 16.43 ）g/L was lower than that in iron normal group patients （118.87 ± 19.51 ） g/L. The difference was statistically significant （P 〈 0. 05 ）. There was no statistically significant difference between the two groups in other indicators such as the rate of glomerular filtration, uric acid, blood lipids and so on. Using partial correlation analysis and correc- ted the hemoglobin which affect pro-BNP： serum ferritin level independently negative correlated with the level of pro-BNP （r = 0. 160, P = 0. 030）. Conclusion The severity （pro-BNP） of heart failure patients in elderly is independent negatively related to the degree of iron deficiency （serum ferritin level）.