促红细胞生长素对充血性心衰患者心脏结构与功能及B型利钠肽的影响  

Effects of Erythropoietin on Cardiac Structure and Function and B-Type Natriuretic Peptide in Patients with Congestive Heart Failure

作　　者：张勇[1] 杜万红[1] 黄洪波[2] 肖创清[3] 刘小阳[1] 杨婧[1] 孟宪琴[1] 李红英[1] 杨浩军[1] 谭兵[1] 陈宏[1] 

机构地区：[1]解放军163医院内四科,长沙410003 [2]解放军163医院特诊科 [3]解放军163医院检验科

出　　处：《华南国防医学杂志》2008年第5期39-42,共4页Military Medical Journal of South China

摘　　要：目的探讨充血性心力衰竭（CHF）并贫血的患者,在促红细胞生长素（EPO）加铁剂治疗后,对心脏结构与功能及B型利钠肽水平的影响。方法32例连续CHF并贫血（血红蛋白：8～12g/dl）的患者纳入本研究。以随机方法分为治疗组（A组,16例）,皮下注射EPO 12 000IU/周＋每天口服铁剂共4个月。对照组（B组,16例）,每天口服铁剂。A组患者完成4个月的治疗后,继续以EPO治疗8个月,在12个月的治疗过程中,2组患者持续口服铁剂。结果A组患者在随机治疗的4个月中,相对于基础状态血红蛋白增加（P〈0.001）,左室内径下降（P〈0.001）,射血分数增加（P〈0.05）,心功能分级（P〈0.001）与6min步行试验（P〈0.05）改善,同时血浆中B型利钠肽水平（P〈0.01）下降。B组患者在试验期间射血分数（P〈0.05）及6min步行距离（P〈0.05）有所下降,其它指标无明显变化。在12个月中,A组与B组比较,A组患者的血红蛋白（P〈0.01）、射血分数（P〈0.001）、6min步行试验距离（P〈0.001）增加,左室内径（P〈0.05）、室间隔厚度（P〈0.01）、心功能分级（P〈0.001）、B型利钠肽水平（P〈0.05）下降。结论对于CHF并贫血的患者,EPO加口服铁剂治疗与单纯口服铁剂的对照组相比,能改善患者的心脏结构与功能,降低B型利尿肽水平。Objective To investigate the effects of erythropoietin （EPO） treatment and oral taking of iron on cardiac structure and function as well as B-type natriuretic peptide （BNP） levels in patients with congestive heart failure （CHF） and anemia.Methods Thirty-two consecutive patients with CHF and anemia （8.0 g/dl〈／[Hb／]〈12 g/dl）, who were eligible for our requirement, were included and randomized to receive either subcutaneous injection of EPO （12 000 IU a week） for 4 months （group A） and daily oral taking of iron, or daily oral taking of iron （group B）. After the 4-month treatment, the patients in group A continued the same treatment for an additional 8 months, and those in group B went on to take iron to a total of 12 months.Results Compared with baseline values, the patients in group A in the first four months treatment, demonstrated an increase in Hb （P〈0.001）, a reduction in LVDD （P〈0.001）, an increase in LVEF （P〈0.05）, significant improvement in New York Heart Association functional class （P〈0.001） and six-minute walking test （P〈0.05）, decrease in plasma B-type natriuretic peptide levels （P〈0.01）, and those in group B fall in LVEF （P〈0.05） and distance in six-minute walking test （P〈0.05）, but no difference in other parameters. Twelve months later, the patients in group A showed higher Hb （P〈0.01） and LVEF （P〈0.001）, longer distance in six-minute walking test （P〈0.001） than those in group B, but lower LVDD （P〈0.05）, IVST （P〈0.01）, New York Heart Association functional class （P〈0.001）, and B-type natriuretic peptide levels （P〈0.05）.Conclusion In CHF patients complicated with anemia, the simultaneous administration of EPO and oral iron for correction of anemia achieves better improvement in cardiac structure and function, and decrease of plasma B-type natriuretic peptide levels.

关 键 词：充血性心力衰竭 贫血 心脏结构 心功能 促红细胞生长素 

分 类 号：R541.61[医药卫生—心血管疾病]