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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) and iron supplementation on the structure and function of heart and the level of B-type natriuretic peptide in patients with congestive heart failure (CHF) and anemia. Methods Thirty-two consecutive patients with CHF and anemia (hemoglobin: 8-12 g / dl) were enrolled in this study. Randomized divided into treatment group (A group, 16 cases), subcutaneous injection of EPO 12 000IU / week + daily oral iron for 4 months. Control group (B group, 16 cases), oral iron daily. After 4 months of treatment, patients in group A continued to be treated with EPO for 8 months. During the 12 months of treatment, both groups continued oral iron supplementation. Results In group A, the hemoglobin increased (P <0.001), the left ventricular diameter decreased (P <0.001), the ejection fraction increased (P <0.05) and the heart function grading <0.001) and 6-minute walking test (P <0.05), meanwhile, plasma B-type natriuretic peptide level decreased (P <0.01). In group B, the ejection fraction (P <0.05) and the walking distance (P <0.05) in 6 min decreased while other indexes did not change significantly. At 12 months, the hemoglobin (P <0.01), ejection fraction (P <0.001), distance from 6min walk test (P <0.001), and left ventricular diameter (P < 0.05). The thickness of interventricular septum (P <0.01), heart function grading (P <0.001) and B type natriuretic peptide (P <0.05) decreased. Conclusions For patients with CHF and anemia, EPO plus oral iron treatment improves cardiac structure and function and decreases type B diuretic peptide in comparison with oral iron alone.