Wu Alan H B, Omland Torbjørn, Wold Knudsen Cathrine, McCord James, Nowak Richard M, Hollander Judd E, Duc Philippe, Storrow Alan B, Abraham William T, Clopton Paul, Maisel Alan S, McCullough Peter A
Department of Laboratory Medicine, University of California, San Francisco, San Francisco General Hospital, 1001 Potrero Ave., California 94110, USA.
Am J Hematol. 2005 Nov;80(3):174-80. doi: 10.1002/ajh.20456.
While anemia is a significant risk factor for poor outcomes in patients with heart failure (HF), it is not in defined guidelines for HF assessment. B-type natriuretic peptide (BNP) is a marker for diagnosis and management of patients with HF. We determined the incidence of anemia in patients with HF and the relationship between BNP and hemoglobin (Hgb) levels in patients with and without HF. Results from the Breathing Not Properly Multinational Trial consisted of 1,586 patients presenting to the emergency department (ED) with dyspnea. Because renal insufficiency is a confounding variable for BNP, patients with a creatinine of >or=2.0 mg/dL were excluded. The remaining data were evaluated from 620 non-HF patients (337 M, 283 F) and 547 HF patients (299 M, 248 F). The New York Heart Association (NYHA) HF classification and ejection fraction by echocardiography were assessed for HF patients. Blood was tested for Hgb, BNP, and creatinine. Using World Health Organization criteria for anemia, we observed that HF patients in NYHA class III or IV had lower mean Hgb levels (12.5 g/dL, P < 0.05) and a higher incidence of anemia (48.2%, P < 0.05) than did HF patients in class I or II (13.4 g/dL and 33.9%, respectively). There was no correlation between Hgb and log BNP for females without HF or the aggregate of all HF patients. In contrast, a significant inverse correlation was observed for males without HF (P < 0.001). Although there were differences in the BMI, age, and estimated glomerular filtration rate (eGFR) versus Hgb observed in this group, the log BNP correlation remained significant after multivariate analysis. A significant inverse correlation for log BNP and Hgb were also observed for diastolic (EF >or= 50) HF (P < 0.05) that was also not accounted for by the BMI, age, or eGFR. The presence of anemia is associated with worsening HF at ED presentation. For males without HF and diastolic HF patients of both genders, a low Hgb may be a confounding variable toward increasing BNP. Among systolic HF patients, the presence of a low hemoglobin concentration is not a factor in the interpretation of BNP results.
虽然贫血是心力衰竭（HF）患者预后不良的一个重要危险因素，但在HF评估的既定指南中并未提及。B型利钠肽（BNP）是HF患者诊断和管理的一个标志物。我们确定了HF患者中贫血的发生率以及有HF和无HF患者中BNP与血红蛋白（Hgb）水平之间的关系。“呼吸不畅”多国试验的结果包括1586名因呼吸困难就诊于急诊科（ED）的患者。由于肾功能不全是BNP的一个混杂变量，肌酐≥2.0mg/dL的患者被排除。对620名非HF患者（337名男性，283名女性）和547名HF患者（299名男性，248名女性）的剩余数据进行了评估。对HF患者评估了纽约心脏协会（NYHA）HF分级和通过超声心动图测定的射血分数。检测了血液中的Hgb、BNP和肌酐。使用世界卫生组织的贫血标准，我们观察到NYHA III级或IV级的HF患者平均Hgb水平较低（12.5g/dL，P<0.05），贫血发生率较高（48.2%，P<0.05），而I级或II级的HF患者分别为13.4g/dL和33.9%。对于无HF的女性或所有HF患者的总体而言，Hgb与log BNP之间无相关性。相比之下，观察到无HF的男性存在显著的负相关（P<0.001）。尽管该组中观察到体重指数（BMI）、年龄和估计肾小球滤过率（eGFR）与Hgb存在差异，但多变量分析后log BNP相关性仍然显著。对于舒张性（射血分数≥50）HF，log BNP与Hgb之间也观察到显著的负相关（P<0.05），这也不能用BMI、年龄或eGFR来解释。贫血的存在与ED就诊时HF的恶化相关。对于无HF的男性和男女两性的舒张性HF患者，低Hgb可能是增加BNP的一个混杂变量。在收缩性HF患者中，低血红蛋白浓度的存在不是解释BNP结果的一个因素。
