贫血、铁缺乏与心衰

发布时间：2018-06-11 13:00

  本文选题：心衰 + 贫血　； 参考：《北京协和医学院》2017年硕士论文

【摘要】：心力衰竭是各种心脏疾病的严重和终末阶段,引起患者生活质量降低,发病率高、死亡率高。心衰常合并多种合并症,如贫血、铁缺乏、肾功能不全、慢性肺部疾病、睡眠呼吸疾病等,影响患者生活质量及预后。贫血是心衰常见合并症,不同研究显示的贫血发生率在4%-70%之间。贫血的原因是复杂且多重的,常见缺铁、血液稀释、促红细胞生成素的产生和功能异常等。以及其他引起贫血的原因如骨髓增生异常综合征、化疗引起等,均会影响患者的预后。贫血引起心衰患者心功能降低、住院周期延长,再住院率增加,死亡率增加。来自阜外医院心衰中心的一项回顾性研究,共纳入2010年至2014年间在北京阜外医院心力衰竭中心主因心衰住院的患者,研究结果显示在1528例心衰患者中,贫血发生率为25.7%。Kaplane Meier生存曲线显示合并贫血者较非贫血者比,住院期间全因死亡风险增加。贫血的治疗应基于其发生的病理生理学机制,才能有效提高血红蛋白水平、组织器官的氧合,甚至预后。在血红蛋白水平显著降低的患者中,可根据输血指南建议短期内静脉输血迅速提高血红蛋白水平。铁剂的补充、促红细胞生成素的使用为心衰治疗常用方法。其中铁缺乏在心衰患者中的发生率为30%-60%,铁缺乏可引起缺铁性贫血,同时在不引起患者贫血的情况下骨骼肌功能障碍,影响心衰患者运动耐力及预后。心衰患者缺铁可分为绝对缺铁和功能性缺铁,两者产生的的原因不同。多项研究表明,补铁治疗可以纠正心衰患者贫血,可以提高心衰患者的6分钟步行距离及峰值氧耗,降低死亡率改善预后。补铁治疗方式可选择静脉补铁和口服补铁。FAIR、CONFIRM研究均表明静脉补铁可改善心衰患者运动耐力、生活质量,改善预后,发生致死性过敏反应及输液局部不良反应少见,在2016年欧洲心衰指南中推荐合并铁缺乏的心衰患者应予静脉补铁治疗(Ⅱa,A)。口服补铁受铁剂吸收效果的影响,在心衰治疗中的有效性仍有争议。
[Abstract]:Heart failure is a serious and terminal stage of various heart diseases, which results in low quality of life, high morbidity and high mortality. Heart failure is often associated with multiple complications, such as anemia, iron deficiency, renal insufficiency, chronic lung disease, sleep respiratory disease and so on, affecting the quality of life and prognosis of patients. Anemia is a common complication of heart failure, with anemia rates ranging from 4 to 70% in different studies. The causes of anemia are complex and multiple, common iron deficiency, hemodilution, erythropoietin production and abnormal function. And other causes of anemia such as myelodysplastic syndrome, chemotherapy-induced, will affect the prognosis of patients. Heart function decreased, hospitalization period prolonged, rehospitalization rate increased and mortality increased in patients with heart failure caused by anemia. A retrospective study from the heart failure center of Fuwei Hospital included patients hospitalized in the heart failure center of Beijing Fuwei Hospital between 2010 and 2014. The results of the study showed that among 1528 patients with heart failure, The incidence of anemia was 25.7. Kaplane Meier survival curve showed that the incidence of anemia was higher than that of non-anemia patients, and the risk of death was increased during hospitalization. The treatment of anemia should be based on its pathophysiological mechanism in order to improve hemoglobin level, oxygenation of tissues and organs, and even prognosis. In patients with significantly reduced hemoglobin levels, short-term intravenous blood transfusion may be recommended to rapidly increase hemoglobin levels according to the transfusion guidelines. Iron supplement, erythropoietin is commonly used in the treatment of heart failure. The incidence of iron deficiency in patients with heart failure is 30-60. Iron deficiency can cause iron-deficiency anemia and skeletal muscle dysfunction without anemia affects exercise endurance and prognosis of patients with heart failure. Iron deficiency in patients with heart failure can be divided into absolute iron deficiency and functional iron deficiency, the causes of which are different. Many studies have shown that iron supplementation can correct anemia in patients with heart failure, increase 6-minute walking distance and peak oxygen consumption of patients with heart failure, and reduce mortality and improve prognosis. The methods of iron supplementation can be chosen by intravenous iron supplementation and oral iron supplementation. The study of CONFIRM shows that intravenous iron supplementation can improve exercise endurance, quality of life and prognosis of patients with heart failure. Fatal allergic reactions and local adverse reactions of transfusion are rare. In the 2016 European guidelines for Heart failure, it is recommended that patients with heart failure associated with iron deficiency should be treated with intravenous iron supplementation (鈪，

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