内源性促红细胞生成素水平和肾功能对慢性心力衰竭患者贫血的影响  

Influence of Endogenous Erythropoietin Levels and Renal Function on Anemia in Patients with Chronic Heart Failure

作　　者：张善春[1] 齐惠英[1] 杜闻莹[1] 郑刚[1] 李广平[2] 

机构地区：[1]天津市第三医院心内科,天津300250 [2]天津医科大学第二医院心内科,天津300211

出　　处：《中国医药导刊》2008年第2期188-191,共4页Chinese Journal of Medicinal Guide

摘　　要：目的:研究慢性心力衰竭(CHF)患者贫血的患病情况及贫血与促红细胞生成素(EPO)和肾功能的关系。方法:对115例CHF患者(年龄73.62±9.31岁)和67例对照者进行血红蛋白(Hb)、血EPO和尿白蛋白与尿肌酐比值(ACR)测定。采用简化MDRD公式计算肾小球滤过率(GFR)。结果:CHF患者中贫血(女性Hb<120g/L;男性Hb<130g/L)者66例(57.4%)。贫血多见于高龄、高NYHA评分及低LVEF者。贫血组脑钠肽(BNP),ACR及GFR较非贫血组有统计学差异(P分别为0.043,0.006和0.044)。EPO在两组间无差别,但贫血组实测与预计logEPO(O/P)比值较非贫血组显著降低[(1.01±0.20)比(1.09±0.20),P=0.041]。CHF患者EPO与Hb中度负相关趋势(R=- 0.188,P=0.045)。Hb与NYHA评分(R=-0.352,P=0.002)、logBNP(R=-0.245,P=0.043)和logACR(R=- 0.293,P=0.003)有相关的趋势。logEPO仅与NYHA评分(R=0.361,P=0.003)有相关趋势,而与其它心、肾功能指标无关。结论:CHF患者常伴有贫血,贫血的程度与心力衰竭的严重程度有关。CHF患者EPO生成障碍和肾功能减弱可能导致贫血的发生。Objective：To investigate the prevalence of anemia and the relation between anemia, erythropoietin （EPO） and renal function in patients with chronic heart failure （CHF）. Methods： In 115 inpatients with CHF （ age 73. 62 ± 9. 31 years ） and in 67 control patients, hemoglobin （Hb） levels and plasma concentrations of EPO and urine Albunfin/creatinine ratio （ACR） were determined and use the simplified Modification of Diet in Renal Disease （MDRD） equation to estimate glomerular filtration rate （GFR）. Results： Anemia （ lib 〈 120 g/L in women and Hb 〈 130 g/L in men ） was present in 66 patients （57.4%）. Anemia was more common in older and higher New York Heart Association （NYHA） class and lower left ventricular ejection fraction （LVEF） patients. Brain natriuretic peptide （ BNP）. ACR and GFR were significantly different in anemic subjects compared with that in non-anemic subjects （P =0.043 and P =0. 006 and P =0. 044, respectively）. EPO levels were comparable between anemia and non-anemic CHF patients, but observed/predicted logEPO （O/P） ratio was significantly reduced in anemic subjects [ （ 1.01±0.20 ） vs. （ 1.09 ± 0. 20）, P = 0. 041 ]. CHF patients displayed a relatively moderate negative correlative tendency between logEPO and Hb levels （R = 4）. 188. P = 0.045 ）. It tend to have correlations between Itb and NYHA class（ R = -0. 352, P = 0. 002 ） and logBNP（ R = 4）. 245, P = 0. 043 ） and IogACR （ R = 4）. 293. P = 0.003 ）. A tendency of correlation was observed only between LogEPO and NYHA class（R = 0.361, P = 0. 003 ）instead of other heart or renal function parameters. Conclusion： Anemia was common in CHF. The degree of anemia is correlated with the severity of heart failure. Blunted EPO production and impaired renal function could be the cause of anemia in CHF.

关 键 词：慢性心力衰竭 贫血 促红细胞生成素 肾功能 

分 类 号：R541.6~1[医药卫生—心血管疾病]