静脉用蔗糖铁治疗老年射血分数下降心力衰竭伴铁缺乏的临床研究  

Clinical study on intravenous iron sucrose in elderly patients with iron deficiency and heart failure with reduced ejection fraction

作　　者：王梦娟[1] 刘振娟 邵桂丽[3] 司君利[4] 赵新闻[5] WANG Mengjuan;LIU Zhenjuan;SHAO Guili;SI Junli;ZHAO Xinwen(Department of Emergency,Qingdao Municipal Hospital,Qingdao,Shandong,26601l,China;Department of Intensive Care Unit,Qingdao Municipal Hospital;Department of Cardiology,the Affiliated Cardiovascular Hospital of Qingdao University;Department of Gastroenterology,Qingdao Municipal Hospital;Department of Cardiology,Qingdao Municipal Hospital)

机构地区：[1]青岛市市立医院急诊科,山东青岛266011 [2]青岛市市立医院重症医学科 [3]青岛大学附属心血管病医院心血管内科 [4]青岛市市立医院消化内科 [5]青岛市市立医院心血管内科

出　　处：《临床急诊杂志》2023年第3期112-118,共7页Journal of Clinical Emergency

摘　　要：目的:评估急性射血分数下降心力衰竭(HFrEF)合并铁缺乏(ID)的老年住院患者出院前静脉应用蔗糖铁的安全性和远期影响。方法:连续入选2017年8月—2019年5月青岛市市立医院急诊科因急性HFrEF住院且合并ID的老年患者140例,出院前随机给予蔗糖铁(n=72)或安慰剂(n=68),测量并评估2组患者出院前及出院后第6、12、24、36、52周的血红蛋白、铁蛋白、纽约心脏协会(NYHA)分级等指标和不良心血管事件(心衰再入院和心血管死亡),并在治疗开始后进行安全性分析。结果:蔗糖铁组和安慰剂组患者临床基线资料差异均无统计学意义(均P>0.05)。蔗糖铁组有40例(55.6%)患者发生心力衰竭(心衰)再入院和心血管死亡复合终点,安慰剂组58例(85.3%),有下降趋势,但差异无统计学意义(P=0.05);2组累积心血管死亡率亦差异无统计学意义[蔗糖铁组18例(25.0%),安慰剂组18例(26.5%),P=0.83]。蔗糖铁组有34例(47.2%)患者发生心衰再入院,安慰剂组有45例(66.2%),蔗糖铁组累积事件率明显低于安慰剂组(P=0.02)。蔗糖铁组患者累积首次心力衰竭住院或心血管死亡的复合终点率明显低于安慰剂组[蔗糖铁组24例(33.3%),安慰剂组32例(47.1%),P=0.04]。2组患者不良事件发生情况差异无统计学意义(P=0.653)。回归分析结果显示,早期静脉应用蔗糖铁的患者心功能从第24周起显著好转(24周P=0.009,52周P=0.008)。结论:早期静脉应用蔗糖铁可持续改善老年HFrEF合并ID患者的心功能,降低心衰再入院的风险,且安全性良好,但对心血管死亡风险无明显影响。Objective: To evaluate the efficacy and safety of intravenous iron sucrose, compared with placebo, before hospital discharge among patients hospitalized for iron deficiency(ID) and acute heart failure with reduced ejection fraction(HFrEF). Methods: A total of 140 hospitalized patients with acute HFrEF and ID in Department of Emergency of Qingdao Municipal Hospital from August 2017 to May 2019 were randomly assigned(1∶1) to receive intravenous iron sucrose(n=72) or placebo(n=68) before hospital discharge. Haemoglobin, serum ferritin, New York Heart Association(NYHA) class, major adverse cardiovascular events(heart failure hospitalizations and cardiovascular death) and so on were analyzed before discharge and at weeks 6, 12, 24, 36 and 52 after discharge. Safety was assessed in all patients for whom treatment was started. Results: The clinical baseline characteristics were similar between iron sucrose group and placebo group(all P>0.05). There were 40(55.6%) cases with total heart failure hospitalizations and cardiovascular death occurred in the iron sucrose group and 58(85.3%) occurred in the placebo group(P=0.05). There was no difference in cardiovascular death rates between the two groups(18[25.0%]in the iron sucrose group vs.18[26.5%]in the placebo group, P=0.83). There were 34(47.2%) cases with total heart failure hospitalizations and cardiovascular death occurred in the iron sucrose group and 45(66.2%) occurred in the placebo group, and cumulative incidence rates in the iron sucrose group were significantly lower than those in the placebo group(P=0.02). Cumulative rates of first heart failure hospitalization or cardiovascular death were lower with iron sucrose than with placebo(24[33.3%]in the iron sucrose group vs.32[47.1%]in the placebo group, P=0.04). There was no dereference in advent events between the two groups(P=0.653). The use of iron sucrose, when compared with placebo, showed a significant benefit in NYHA class from week 24 onwards(P=0.009 at week 24 and P=0.008 at week 52). Conclusion: Treatment

关 键 词：射血分数下降心力衰竭 急性 蔗糖铁 铁缺乏 

分 类 号：R541.6[医药卫生—心血管疾病]