Silverberg Donald S, Wexler Dov, Iaina Adrian
Department of Nephrology, Tel Aviv Medical Center, Weizman 6, Tel Aviv 64239, Israel.
Eur J Heart Fail. 2002 Dec;4(6):681-6. doi: 10.1016/s1388-9842(02)00115-0.
About half of all the patients with CHF are anemic (they have a hemoglobin of < 12 g%). The prevalence and severity of this anemia increase with increasing severity of the CHF. The anemia is caused by a combination of poor nutrition, associated renal insufficiency causing inappropriately low Erythropoietin (EPO) levels, bone marrow depression and EPO resistance caused by excessive TNF alpha and other factors, gastrointestinal blood loss caused by aspirin, ACE inhibitors, EPO loss in the urine with proteinuria, and hemodilution caused by the excessive plasma volume. Studies have shown that the anemia is an independent risk factor for death in CHF, almost doubling the mortality rate. Correction of the anemia with subcutaneous EPO and IV iron improves cardiac function and functional capacity, helps prevent the progression of renal failure, markedly reduces hospitalization and diuretic doses, and improves self assessed quality of life. This so-called Cardio Renal Anemia Syndrome is very common in CHF. Its successful treatment demands close cooperation between cardiologists and nephrologists.
约一半的慢性心力衰竭（CHF）患者存在贫血（血红蛋白<12 g%）。随着CHF严重程度的增加，这种贫血的患病率和严重程度也会升高。贫血是由多种因素共同导致的，包括营养不良、相关的肾功能不全导致促红细胞生成素（EPO）水平异常降低、骨髓抑制以及由过量肿瘤坏死因子α和其他因素引起的EPO抵抗、阿司匹林和血管紧张素转换酶抑制剂导致的胃肠道失血、蛋白尿时尿液中EPO丢失以及血浆容量过多导致的血液稀释。研究表明，贫血是CHF患者死亡的独立危险因素，几乎使死亡率翻倍。皮下注射EPO和静脉注射铁剂纠正贫血可改善心脏功能和功能能力，有助于预防肾衰竭的进展，显著减少住院次数和利尿剂用量，并改善自我评估的生活质量。这种所谓的心肾贫血综合征在CHF中非常常见。其成功治疗需要心脏病专家和肾病专家密切合作。
