Jones Michael, Schenkel Brad, Just Julie
Jones and Just Pty Ltd and Department of Psychology, Macquarie University, Sydney, Australia.
Int J Cardiol. 2005 Apr 20;100(2):253-65. doi: 10.1016/j.ijcard.2004.08.051.
Improving anemia in patients with chronic renal failure (CRF) and congestive heart failure (CHF) also improves left ventricular hypertrophy (LVH). No previous meta-analyses have been conducted to further examine this association, including the association between LVH and mortality in these patients.
Literature searches on MEDLINE, EMBASE, and OVID were performed using Cochrane Library protocols. Two hundred sixteen abstracts were reviewed preliminarily for inclusion in the meta-analysis of epoetin alfa, anemia and 5 pre-selected parameters of LVH. One hundred seventy-nine abstracts were reviewed for LVH and mortality. The predominant hematologic and left ventricular function changes observed during epoetin alfa treatment in patients with CHF and CRF are (1) increases in hemoglobin (Hb) and hematocrit (Hct); (2) decreases in left ventricular mass (LVM) and LVM index; (3) increase in ejection fraction (EF); and (4) decreases in left ventricular end-diastolic and end-systolic volume. Three independent factors-target Hb, duration of disease, and duration of follow-up-each had a statistically significant association with Hb, Hct, and EF, respectively. A separate meta-analysis using 3 risk models showed LVH is strongly and positively associated with both cardiovascular and all-cause mortality, with two- to three-fold increases in risk.
LVH is common in patients with CRF and CHF. Current findings indicate epoetin alfa therapy results in anemia amelioration, as evidenced by higher Hb and Hct levels, and reduction of key LVH parameters. LVM regression is associated with lower incidence of cardiovascular-related morbidity and mortality, therefore epoetin alfa therapy may provide a survival benefit.
改善慢性肾衰竭（CRF）和充血性心力衰竭（CHF）患者的贫血状况也能改善左心室肥厚（LVH）。此前尚未进行过荟萃分析来进一步研究这种关联，包括LVH与这些患者死亡率之间的关联。
按照Cochrane图书馆方案在MEDLINE、EMBASE和OVID上进行文献检索。初步审查了216篇摘要，以纳入促红细胞生成素α、贫血和5个预先选定的LVH参数的荟萃分析。对179篇摘要进行了LVH与死亡率方面的审查。在CHF和CRF患者接受促红细胞生成素α治疗期间观察到的主要血液学和左心室功能变化为：（1）血红蛋白（Hb）和血细胞比容（Hct）升高；（2）左心室质量（LVM）和LVM指数降低；（3）射血分数（EF）升高；（4）左心室舒张末期和收缩末期容积降低。三个独立因素——目标Hb、病程和随访时间——分别与Hb、Hct和EF存在统计学上的显著关联。使用3种风险模型进行的单独荟萃分析显示，LVH与心血管死亡率和全因死亡率均呈强烈正相关，风险增加两到三倍。
LVH在CRF和CHF患者中很常见。目前的研究结果表明，促红细胞生成素α治疗可改善贫血状况，表现为Hb和Hct水平升高，并降低关键LVH参数。LVM的消退与心血管相关发病率和死亡率的较低发生率相关，因此促红细胞生成素α治疗可能带来生存益处。
