慢性心力衰竭患者贫血的发生及对预后的影响

Incidence of anemia and its influence on prognosis of patients with chronic heart failure

目的回顾性地分析慢性心力衰竭（CHF）住院患者贫血发生率及对死亡率的影响。方法选择2006年1月至2015年10月在商洛市中心医院心血管内科住院的CHF患者481例，根据纽约心脏协会（NYHA）分级标准分为I组、Ⅱ组、Ⅲ组、Ⅳ组。根据血红蛋白（Hh）浓度分为Hb〈80，80～99，100～119，120～139，140～159，〉160g／L六个亚组，比较不同组实验室指标及预后情况。结果（1）随着心力衰竭程度的加重，左室射血分数（LVEF）、Hb、红细胞压积（HCT）水平明显降低；血肌酐（SCr）水平和贫血发生率逐渐增高，组间比较差异均有统计学意义（P〈0．05）。（2）贫血组患者在年龄、严重心力衰竭（Ⅲ级和Ⅳ级）患者的比率、LVEF、死亡率方面与非贫血组比较，差异有统计学意义（P〈0．05）。（3）Hb120～139g／L组的SCr水平明显低于其他组（P〈0．01）。Hb140～159g／L组死亡率最低（2．4％，P〈0．01）。（4）多因素logistic回归分析表明，心功能分级、年龄、SCr、LVEF是住院死亡率增高的危险因素，而Hh则是住院死亡率降低的保护因素。结论合并贫血的CHF患者病情重，死亡率高。临床医师在积极抗心力衰竭治疗的同时应重视贫血的纠正，以更好地改善CHF患者的预后。

Objective To analyze the incidence of anemia and its effect on the mortality of the patients with chronic heart failure （CHF） retrospectively. Methods A total of 481 CHF patients admitted in our department from January 2006 to October 2015 were enrolled in this study. They were divided into groups I - IV according to their cardiac function by New York Heart Association （NYHA） Functional Classification. They were also assigned into 6 groups based on hemoglobin （Hb） level, that is, 〈 80, 80 -99, 100- 119, 120- 139, 140 -159, and 〉 160 g/L group. Their laboratory parameters and prognoses were analyzed and compared among the different groups. Results （ 1 ） With the increasing severity of heart failure （ from the NYHA Class I to IV ）, the left ventricular ejection fraction （LVEF）, Hb level, and hematocrit （HCT） were significantly decreased, but serum ereatinine （SCr） and the incidence of anemia were significantly increased. Significant differences were observed among the intra-groups （ P 〈 O. 05 ）. （ 2 ） There were obvious differences in age, proportion of severe heart failure （ NYHA Class BI and IV ） , LVEF and mortality between the anemia group and non-anemia group （ P 〈 0. 05 ）. （ 3 ） SCr level was the lowest in the patients with Hb of 120 - 139 g/L （ P 〈 0. 01 ）, and hospital mortality was the lowest in the patients with Hb of 140 - 159 g/L （2.4%, P 〈 0.01 ）. （4） Multivariate logistic regression analysis showed that the cardiac function classification, age, SCr and LVEF were the risk factors for hospital mortality, but Hb was the protective factor. Conclusion CHF patients complicated with anemia are commonly in severe condition and associated with high mortality. Therefore, clinicians should actively treat heart failure and correct anemia at the same time in order to improve the prognosis of the patients.