Foley R N, Parfrey P S, Morgan J, Barré P E, Campbell P, Cartier P, Coyle D, Fine A, Handa P, Kingma I, Lau C Y, Levin A, Mendelssohn D, Muirhead N, Murphy B, Plante R K, Posen G, Wells G A
The Health Sciences Center, Memorial University of Newfoundland, Saint John's, UK.
Kidney Int. 2000 Sep;58(3):1325-35. doi: 10.1046/j.1523-1755.2000.00289.x.
Hemoglobin levels below 10 g/dL lead to left ventricular (LV) hypertrophy, LV dilation, a lower quality of life, higher cardiac morbidity, and a higher mortality rate in end-stage renal disease. The benefits and risks of normalizing hemoglobin levels in hemodialysis patients without symptomatic cardiac disease are unknown.
One hundred forty-six hemodialysis patients with either concentric LV hypertrophy or LV dilation were randomly assigned to receive doses of epoetin alpha designed to achieve hemoglobin levels of 10 or 13.5 g/dL. The study duration was 48 weeks. The primary outcomes were the change in LV mass index in those with concentric LV hypertrophy and the change in cavity volume index in those with LV dilation.
In patients with concentric LV hypertrophy, the changes in LV mass index were similar in the normal and low target hemoglobin groups. The changes in cavity volume index were similar in both targets in the LV dilation group. Treatment-received analysis of the concentric LV hypertrophy group showed no correlation between the change in mass index and a correlation between the change in LV volume index and mean hemoglobin level achieved (8 mL/m2 per 1 g/dL hemoglobin decrement, P = 0.009). Mean hemoglobin levels and the changes in LV mass and cavity volume index were not correlated in patients with LV dilation. Normalization of hemoglobin led to improvements in fatigue (P = 0.009), depression (P = 0.02), and relationships (P = 0.004).
Normalization of hemoglobin does not lead to regression of established concentric LV hypertrophy or LV dilation. It may, however, prevent the development of LV dilation, and it leads to improved quality of life.
血红蛋白水平低于10 g/dL会导致左心室（LV）肥厚、左心室扩张、生活质量下降、心脏发病率升高以及终末期肾病死亡率升高。在无症状性心脏病的血液透析患者中，使血红蛋白水平正常化的益处和风险尚不清楚。
146例患有同心性左心室肥厚或左心室扩张的血液透析患者被随机分配接受剂量的促红细胞生成素α，以达到血红蛋白水平为10或13.5 g/dL。研究持续时间为48周。主要结局是同心性左心室肥厚患者的左心室质量指数变化以及左心室扩张患者的腔室容积指数变化。
在同心性左心室肥厚患者中，正常目标血红蛋白组和低目标血红蛋白组的左心室质量指数变化相似。左心室扩张组中两个目标的腔室容积指数变化相似。对同心性左心室肥厚组的治疗接受分析显示，质量指数变化与左心室容积指数变化之间无相关性，而左心室容积指数变化与达到的平均血红蛋白水平相关（每降低1 g/dL血红蛋白，左心室容积指数变化8 mL/m²，P = 0.009）。左心室扩张患者的平均血红蛋白水平与左心室质量和腔室容积指数变化无关。血红蛋白正常化可改善疲劳（P = 0.009）、抑郁（P = 0.02）和人际关系（P = 0.004）。
血红蛋白正常化不会导致已形成的同心性左心室肥厚或左心室扩张消退。然而，它可能会预防左心室扩张的发生，并改善生活质量。
