人重组促红细胞生成素联合铁剂治疗慢性心力衰竭合并贫血患者187例疗效观察

摘要

目的 探讨使用人重组促红细胞生成素( EPO)加铁剂治疗慢性心力衰竭( CHF)合并贫血患者的临床疗效. 方法 纳入在2007至2014年我院门诊及住院部治疗的CHF合并贫血的患者187例,随机分为单纯铁剂组( 62例)、单纯EPO组(62例)及联合治疗组(63例). 单纯铁剂组予以口服铁剂(力蜚能0. 15g/次,1次/d);单纯EPO组予以皮下注射EPO 2000U/次,3次/周;联合治疗组予以皮下注射EPO 2000U/次,3次/周,同时口服力蜚能0. 15g/次,1次/d. 共治疗6个月,观察治疗前、治疗后及随访12月时血红蛋白( Hgb)、B型脑利钠肽( BNP)、左室射血分数( LVEF)、左室舒张末内径(LVDd)、6分钟步行距离(6-MWD)等指标,并随访观察不良反应. 结果 相比较治疗前,三组患者在治疗后以及随访1年后,Hgb增加,LVDd缩小,LVEF增加,心功能分级与6-MWD改善,同时血浆中BNP水平下降,差异有统计学意义(P＜0. 05). 联合治疗组治疗后较单纯EPO组及铁剂组,在Hgb的升高、LVDd的减少,LVEF的增加及6-MWD的提高方面差异有统计学意义( P＜0. 05 ). 结论 EPO加口服铁剂治疗CHF并贫血患者,能改善患者的心脏结构与功能,降低BNP水平.%Objective To explore the applied effectiveness of Erythropoietin( EPO) in Chronic Congestive Heart Failure ( CHF) with anemia. Methods 187 patients CHF with anemia were divided at random into three groups: Ferrous group (62cases),EPO group(62cases),Combine group(63cases).Ferrous were given to the ferrous group;EPO were given to the EPO group. EPO and ferrous were given to the treatment group,and the duration of therapy was 6 months. Hemoglobin,B-type natriuretic peptide(BNP),left ventricle ejection fraction(LVEF),diameter of diastolic left ventricle(LVDd),6 minute walking distance (6-MWD),heart function(NYHA functional class)were measured before and after therapy immediately and 12 months later. Re-sults After therapy for six months and follow up for 12 months, the level of Hemoglobin, LVEF and 6-MWD were increased, and BNP,NYHA functional class and LVDd were significant decreased after the therapy in all the groups(all P＜0. 05). All the inde-xes of Combine group were significant changed compared to other two groups(P＜0. 05). Conclusion On basis of regular treat-ment of anti heart failure, intervention with EPO and ferrous against anemia could decrease the level of BNP and improve heart function of CHF with anemia.