住院慢性心力衰竭患者贫血患病率及血红蛋白浓度变化与其心功能的相关性  

Relationship of prevalence of anemia and hemoglobin concentration with cardiac function in inpatients with chronic cardiac failure

作　　者：叶长青[1] 郑兴[1] 赵仙先[1] 丁继军[1] 

机构地区：[1]解放军第二军医大学长海医院心内科,上海市200433

出　　处：《中国临床康复》2006年第44期22-25,共4页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:回顾性分析住院慢性心力衰竭患者贫血患病率及其与NYHA心功能分级之间的关系,进一步评估血红蛋白浓度变化对慢性心力衰竭患者住院死亡率的影响。方法:选取1993-01/2005-09解放军第二军医大学长海医院和解放军第一二三中心医院收治住院的慢性心力衰竭患者1415例,均符合NYHA心功能分级标准,心力衰竭病史≥6个月。排除所有可能引起继发性贫血的患者。①1415例患者血红蛋白浓度值取入院后最早的有效实验室检测值,于肘部静脉或大隐静脉采血。心脏彩超、血液生化指标等其他临床资料均取入院后最早的有效检查结果。②心功能水平的诊断采用NYHA心功能分级,Ⅰ级和Ⅱ级为轻度心力衰竭,Ⅲ级和Ⅳ级为严重心力衰竭。血红蛋白水平<120g/L为贫血。③血红蛋白浓度对慢性心力衰竭患者住院死亡率的影响通过多元Logistic回归分析进行统计学处理。结果:①1415例患者中有413例贫血(29.2%),贫血患病率与患者心功能分级之间呈正相关(心功能Ⅰ级17.9%,Ⅱ级24.7%,Ⅲ级26.3%,Ⅳ级43.1%)。严重心力衰竭患者(Ⅲ级和Ⅳ级)贫血患病率明显高于轻度心力衰竭(Ⅰ级和Ⅱ级)患者(32.2%,24.3%,P<0.01)。②血红蛋白浓度120～139g/L时血清肌酐最低,为(85±29)μmol/L;血红蛋白浓度140～159g/L时住院死亡率最低,为2.7%。对于血红蛋白小于160g/L的心力衰竭患者,通过多元Logistic回归分析表明,心功能分级增高(OR=2.797,95%可信区间)、血清肌酐升高(OR=1.774,95%可信区间)是住院死亡率增高的危险因素,而血红蛋白浓度升高(OR=0.816,95%可信区间)是住院死亡率增高的保护因素。结论:住院慢性心力衰竭患者中贫血相对普遍,贫血与心力衰竭的严重程度密切相关。血红蛋白浓度显著影响慢性心力衰竭患者的住院死亡率,是慢性心力衰竭患者住院死亡率独立的危险预测因子。AIM： To analyze retrospectively the prevalence of anemia and its correlation with NYHA-class in inpatients with chronic cardiac failure （CCF） and assess the effect of different hemoglobin level on the hospital mortality in patients with CCF. METHODS： A total of 1 415 CCF patients who were treated at Changhai Hospital, Second Military Medical University of Chinese PLA and the 123 Central Hospital of Chinese PLA were enrolled from January 1993 to September 2005. The patients were accorded with NYHA cardiac functional grading with a history of cardiac failure for at least 6 months. The patients who could induce secondary anemia were excluded. （1）The original effective test result of hemoglobin concentration in 1 415 patients were gained. Blood was isolated from vein of elbow or great saphenous vein. The clinical data such as original effective test result of color ultrasound and biochemical indexes were gained. （2）Cardiac function was diagnosed with NYHA cardiac functional grading. It was concluded that Ⅰ class and Ⅱclass represented mild cardiac failure; Ⅲclass and Ⅳ class represented severe cardiac failure. Less than 120 g/L haemoglobin indicated anemia. （3）Effect of haemoglobin on hospital mortality of CCF patients was disposed statistically with multiple factors Logistic regression analysis. RESULTS： （1）Of the 1 415 patients, there were 413 cases of anemia （29.2%）. The prevalence of anemia had positive correlation with cardiac functional grading （17.9% in Ⅰ class, 24.7% in Ⅱclass, 26.3% in Ⅲ class and 43.1% in Ⅳ class of cardiac function）. The prevalence of anemia in severe CCF patients （Ⅲ class and Ⅳ class） was significantly higher than that in the mild CCF patients （ Ⅰ class and Ⅱ class） （32.2%,24.3%, P 〈 0.01 ）. （2）Serum creatinine was （85±29） μmol/L, the lowest, in patients with 120-139 g/L haemoglobin. The hospital mortality was 2.7%, the lowest, in patients with 140-159 g/L haemoglobin. For the cardiac failure patients

关 键 词：贫血 心力衰竭 充血性 血红蛋白测定 

分 类 号：R541.83[医药卫生—心血管疾病]