静脉使用蔗糖铁治疗老年人射血分数保留心力衰竭合并铁缺乏的疗效观察

Effect of intravenous iron sucrose in the treatment of elderly heart failure with preserved ejection fraction and iron deficiency

目的观察老年射血分数保留心力衰竭（HFpEF）合并铁缺乏（ID）患者静脉使用蔗糖铁治疗能否改善心功能。方法选取安阳地区医院心内科2016年6～12月治疗的老年HFpEF合并ID患者（年龄≥65岁）89例，采用随机数字表法分为治疗组45例和对照组44例，两组患者均给予常规抗心力衰竭药物治疗。治疗组在常规药物治疗的基础上静脉注射蔗糖铁注射液200mg，每周1次。两组患者均每月检验血清铁蛋白（SF）、转铁蛋白饱和度（TS）及血红蛋白（Hb）水平，两组患者均于0个月、6个月行心脏彩色多普勒超声、6分钟步行试验（6MWT）、静脉血氨基端脑钠肽前体（NT-proBNP）检查。观察两组患者治疗6个月前后左心房内径（LAD）、二尖瓣早期血流速度／舒张晚期血流速度比值（E／A）、左心室舒张末期内径（LVEDD）、6MWT、NT—proBNP等心功能指标的变化。结果治疗前，两组sF、TS、Hb、LAD、LVEDD、NT—proBNP、E／A、6MWT差异均无统计学意义（均P〉0．05）。治疗后，治疗组SF、TS、Hb分别为（244．23±1．69）μg/L、（26．17±1．15）％、（132．08±3．15）g／L，均高于对照组的（30．70±7．11）μg／L、（10．10±9．31）％、（111．0±0．08）g／L，差异均有统计学意义（t=32．661、9．881、25．123，均P〈0．05）；治疗组LVEDD、LAD、NT—proBNP分别为（50．70±7．11）mm、（32．17±0．35）mm、（1077．17±9．35）ng／L，均低于对照组的（54．23±1．69）mm、（36．10±3．31）mm、（1636．10±0．31）ng／L，差异均有统计学意义（t=8．123、6．984、11．484，均P〈0．05）；治疗组E／A、6MWT分别为（1．18±0．15）、（414．23±5．69）m，均高于对照组的（0．97±0．33）、（350．70±7．11）m，差异均有统计学意义（t=4．168、12．123，P〈0．05）。结论静脉使用蔗糖铁治疗可改善老年HFpEF合并ID患者心功能。

Objective To discuss the effect of intravenous iron sucrose in the treatment of elderly heart failure with preserved ejection fraction（HFpEF） and iron deficiency（ID）. Methods From June 2016 to December2016,89 elderly patients with HFpEF and ID（ age ≥ 65 years old） in Anyang Prefecture Hospital were randomly divided into treatment group （ n = 45 ） and control group （ n = 44）. The two groups were treated with routine drugs for heart failure. The treatment group was intravenously given iron sucrose injection once a week on the basis of conventional treatment. The SF,TS and Hb were tested in the two groups every month. The echocardiography Doppler, six minutes walk test （6MWT） and N- terminal probrain natriuretic peptide（ NT- proBNP） before and after experiment were examined in two groups. The changes of left artial diameter（ LAD）, the mitral valve early flow velocitye/the late diastolic blood flow velocity ratio（E/A） ,left ventricular end diastolic （LVEDD）, 6MWT, NT - proBNP were observed in the two groups before and after six months treatment. Results Before treatment, the levels of ST, TS, Hb, LAD, LVEDD, NT - proB- NP,E/A, 6MWT in the two groups had no statistically significant differences （P 〉 0. 05 ）. After treatment for 6 months,the levels of ST,TS and Hb in the treatment group were significantly higher than those in the control group [ （244.23 ± 1.69.） μg/L vs. （30.70 ±7.11） μg/L, （26.17 ±1.15）% vs. （10.10 ±9.31）% ,（132.08 ±3.15） g/L vs. （111.0 ±0.08） g/L] （t =32.661,9. 881,25. 123 ,all P 〈0.05）. The levels of LVEDD,LAD and NT - proBNP of the treatment group were significantly lower than those of the control group [ （ 50.70 ± 7.11 ） mm vs. （ 54.23 ± 1.69） mm,（32.17 ±0.35）mm vs. （36.10 ±3.31）mm, （1077.17 ±9.35） ng/L vs. （1636.10 ±0.31） ng/L] （t =8. 123,6.984,11. 484, all P 〈 0.05 ）. The levels of E/A ,6MWT of the treatment group were significantly higher than those of the control group[ （ 1.18 ±0. 15） vs. （0.97 ± 0.33 ）, （414.23 ± 5.69） m vs （350.70 ± 7.11 ） m ] （ t = 4. 168,12. 123, all P 〈 0.05 ）. Conclusion Intravenous iron sucrose can improve cardiac function in the elderly patients with HFpEF and ID.