静脉补充铁剂对心力衰竭伴铁缺乏患者预后的影响

Effect of intravenous iron therapy in iron-deficient patients with chronic heart failure

目的:探讨静脉补充铁剂对心力衰竭伴铁缺乏患者预后的影响。方法:选取就诊于我院心内科的慢性心力衰竭患者(CHF)100例作为研究对象。采用计算机生成随机数字,将研究对象按照1:1的比例随机分配到干预组(静脉注射铁剂)和对照组(静脉注射生理盐水)。主要结局指标为6min步行距离。次要结局指标为:第24周NYHA心功能分级;心衰及其他心血管相关疾病再入院率;心衰及其他心血管相关疾病导致的死亡。结果:铁剂干预组与对照组相比,两组在年龄、性别及各项临床指标上无明显差异。干预前后自身比较发现,对照组6MWD、高敏反应C-蛋白、NT-proBNP水平差异无统计学意义,干预组6MWD、高敏反应C-蛋白、NT-proBNP水平显著改善。干预24周后组间比较发现,相较于对照组,干预组6MWD、高敏反应C-蛋白、NT-proBNP水平显著改善。在随访期间,干预组和对照组分别有3例和4例患者因心衰加重再入院。对照组有1例患者发生心源性死亡,干预组无死亡发生。两者无事件(无再住院或死亡)生存率差异无统计学意义。结论:对于铁缺乏的慢性心力衰竭患者,给与静脉铁剂补充治疗可以显著改善患者短期活动耐量。

Objective To investigate the effect of intravenous iron therapy in iron-deficient patients with systolic heart failure.Methods One hundred patients with chronic heart failure(CHF)in the Department of Cardiology of our hospital were included.The subjects were randomly assigned in a 1:1 fashion to either the intervention group(intravenous iron injection)or control group(intravenous saline injection).And the randomization sequence was generated by computer.The main outcome was 6 minutes walking distance(6MWD).Secondary outcome indicators were NYHA cardiac function classification after 24 weeks’treatment,readmission rates for heart failure and other cardiovascular-related diseases,and heart failure and other cardiovascular-related death.Results There were nonsignificant difference in age,sex and clinical indicators between the two groups.Self-comparison before and after intervention showed that there was no significant difference in 6MWD,high sensitivity C-protein and NT-proBNP in the control group.However,6MWD,high sensitivity C-protein and NT-proBNP in the intervention group were significantly improved.Comparison between groups after 24 weeks of intervention found that 6MWD,high sensitivity C-protein and NT-proBNP in the intervention group were significantly improved than those in the control group.During the follow-up period,3 patients in the intervention group and 4 patients in the control group were re-admitted due to worsening heart failure.One patient in the control group had cardiogenic death,while no death occurred in the intervention group.There was no significant difference in the event-free(no re-hospitalization or death)survival rate between the two groups.Conclusion Intravenous iron supplementation can significantly improve short-term activity tolerance for iron-deficient patients with chronic heart failure.