【摘要】 目的:探讨低剂量重组人促红细胞生成素(rhEPO)加铁剂治疗重症慢性充血性心力衰竭合并贫血的临床安全性以及对临床预后的影响。方法:入选慢性心力衰竭纽约心功能分级Ⅲ级以上、左心室射血分数(LVEF)<0.4且血红蛋白<100 g/L的患者共128例,随机分为贫血治疗组(n=66)和对照组(n=62)。随访12个月,记录2组无事件生存时间、主要终点事件(心衰恶化住院、心衰死亡)、次要终点事件(非心衰死亡、猝死、心肌梗死、不稳定性心绞痛、卒中、动脉栓塞、药物不良反应导致停药)。比较两组存活患者治疗前后的LVEF、左心室室壁应力(MWS)、左心室质量指数(LVMI)以及肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(hsCRP)和B型利钠肽(BNP)水平。结果:与对照组比较,治疗组无事件生存时间延长,但心衰死亡和心衰恶化住院率无显著性差异;非心衰心血管事件治疗组未增加。治疗组MWS和LVMI在治疗后显著降低,与对照组差异显著,而LVEF、BNP、TNF-α以及hsCRP水平两组无差异。结论:低剂量rhEPO加用铁剂治疗可安全用于重症充血性心力衰竭合并贫血患者,能延长生存时间和改善左心室功能,但不降低心衰病死率和心衰恶化入院率。更多还原

【Abstract】 Objective:To evaluate the clinical safety and efficacy of treating severe chronic congestive heart failure accompanied by anemia using low-dose recombinant human erythropoietin(rhEPO) plus iron.Methods:A total of 128 patients with chronic heart failure(NYHA functional class Ⅲ and above),left ventricular ejection fraction less than 0.4,and hemoglobin level below 100g/L were selected and randomly divided into the anemia treatment group(n=66) and the control group(n=62).A 12-month follow-up observational study was conducted to record event-free survival,primary endpoint events(hospitalization due to worsening heart failures,deaths from heart failures),and secondary endpoint events(deaths from causes other than heart failure,sudden deaths,myocardial infarctions,unstable anginas,strokes,arterial embolisms,and discontinuations due to adverse drug reactions).Left ventricular ejection fraction(LVEF),wall stress(MWS),mass index(LVMI),TNF-α,hsCRP,and BNP levels before and after the treatment were compared between the two groups.Results:Compared with the control group,the treatment group had longer event-free survival time,but showed no significant differences in heart failure-induced death and hospitalization rates.Also,no increase in cardiovascular events was observed in the treatment group.MWS and LVMI values decreased significantly after the treatment in the treatment group,in striking contrast with the control group.However,no differences were seen between the two groups in the LVEF,BNP,TNFa,and hsCRP levels.Conclusion:Patients with severe chronic congestive heart failure accompanied by anemia can be safely treated using low-dose rhEPO plus iron.Preliminary studies show that this approach can elongate survival time and improve left ventricular functions,but does not necessarily lower heart failure-induced death and hospitalization rates.更多还原