贫血对慢性心力衰竭患者预后影响的临床研究  

Clinical study on the influence of anemia on the prognosis of patients with chronic heart failure

作　　者：杨阳柳林 吴华芹[1] 胡元会[1] 褚瑜光[1] 商秀洋[1] 石洁[1] 宋庆桥[1] 

机构地区：[1]中国中医科学院广安门医院,北京100053

出　　处：《北京中医药》2017年第3期195-200,共6页Beijing Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81573799)

摘　　要：目的探讨血红蛋白(Hb)及贫血对慢性心力衰竭(CHF)患者预后的影响因素。方法回顾性收集CHF患者临床资料,每月对患者进行门诊或电话随访,历时2年,获取终点事件(全因死亡)的发生及其时间。绘制ROC曲线建立CHF患者Hb及红细胞分组标准,并对2组进行Kaplan-Meier生存分析,探讨其对CHF患者的预后价值,采用Spearman相关分析探索CHF合并贫血的相关指标。结果 409例CHF患者的全因死亡率为28.6%,分析取得Hb切值为110.5 g/L;根据切值分组,采用Kaplan-Meier生存分析得出Hb低值组的CHF患者远期预后较差(P=0.002);气虚证与贫血具有相关性(P<0.05)。CHF患者的贫血程度与性别、RBC计数、低密度脂蛋白呈正相关;与年龄、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素、直接胆红素、间接胆红素、肌酐、尿素氮、LVEF值、高血压呈负相关(P<0.05)。结论 Hb低于110.5 g/L的CHF患者2年死亡率高,气虚对贫血有促进作用,随着年龄、肌酐、尿素氮、转氨酶、胆红素指标的升高,Hb浓度、低密度脂蛋白及LVEF值降低,贫血明显。Objective To investigate the value of hemoglobin（ HB） and anemia for the prognosis of patients with chronic heart failure（ CHF） and its influential factors. Methods The clinical data of patients with CHF were retrospectively collected. The patients were followed up through clinic visit or phone call each month for 2 years. The incidence and time of the end event（ all of the death） were obtained. ROC curves were drawn to establish HB and red blood cell grouping criteria of patients with CHF and Kaplan-Meier survival analysis were made on the data of two groups to evaluate the prognostic value for them,the related indexes of Spearman correlation analysis were used to explore the correlation index in chronic heart failure complicated with anemia. Results The total mortality of 409 patients with CHF was 28. 6%,and HGB cut value was 110. 5 g/L achieved by the analysis. According to the value of the cut group,Kaplan-Meier survival analysis was used to analyze the long-term prognosis of CHF patients with poor prognosis of Hb value group P =0. 002; Qi deficiency syndrome was associated with anemia（ P〈0. 05）. The severity of anemia in patients with CHF were positively correlated with sex, RBC count and low density lipoprotein（ LDL） and negatively correlated with age, alanine aminotransferase（ ALT）,aspartate aminotransferase（ AST）,total bilirubin（ TBIL）,direct bilirubin（ D-BIL）,indirect bilirubin（ I-BIL）,creatinine（ Cr）,urea nitrogen（ BUN）,LVEF value,and hypertension（ P〈0. 05）. Conclusion In CHF patients with HB less than 110. 5 g/L,the mortality rate in 2 years is very high,Qi deficiency has a promoting effect on anemia,which become more obvious with an increase of age,Cr,BUN,ALT,AST,and a decrease of HB concentration,LDL and LVE.

关 键 词：慢性心力衰竭 贫血 预后 证候 

分 类 号：R259[医药卫生—中西医结合]