Palazzuoli Alberto, Silverberg Donald S, Iovine Francesca, Calabrò Anna, Campagna Maria S, Gallotta Maddalena, Nuti Ranuccio
Department of Internal Medicine and Metabolic Diseases, Section of Cardiology, Le Scotte Hospital, University of Siena, Siena, Italy.
Am Heart J. 2007 Oct;154(4):645.e9-15. doi: 10.1016/j.ahj.2007.07.022.
Although anemia is frequently found in congestive heart failure (CHF), little is known about the effect of its correction with erythropoietin (EPO) on cardiac structure and function.
The present study examines in patients with advanced CHF, chronic renal insufficiency, and anemia the effects of beta-EPO on left ventricular (LV) systolic diameter and volume (LVSD and LVSV), LV diastolic diameter and volume (LVDD and LVDV), LV mass, LV ejection fraction (LVEF), pulmonary artery pressure (PAP), and B-type natriuretic peptide (BNP) levels.
Fifty-one consecutive subjects affected with advanced CHF and anemia were studied. We performed a randomized double-blind controlled study of correction of anemia with subcutaneous EPO for 4 months (group A, 26 patients) using saline as the placebo in the control group (group B, 25 patients). We then maintained the EPO treatment in the treated group for another 8 months. Both groups received oral iron throughout the total 12-month period. Echocardiographic evaluation, BNP levels, and hematological parameters are reported at 4 and 12 months.
The patients in group A during the double-blind phase (4 months) demonstrated an increase in LVEF and mild reduction in LVSD and LVSV with respect to baseline and to group B with no differences in PAP, LVDD, and LVDV. Over the 12-month period, the hemoglobin increased from 10.40.6 to 12.4 +/- 0.8 g/dL (P < .01) in group A but did not change in group B. Compared with group B, group A had lower LVDD, LVSD, LVDV, LVSV, LV mass, PAP, and BNP and higher LVEF. The serum creatinine and creatinine clearance remained unchanged in the 2 groups.
In anemic patients with CHF, correction of anemia with EPO and oral iron over 1 year lead to an improvement in LV systolic function, LV remodeling, BNP levels, and PAP compared with a control group in which only oral iron was used.
尽管贫血在充血性心力衰竭（CHF）中很常见，但关于使用促红细胞生成素（EPO）纠正贫血对心脏结构和功能的影响知之甚少。
本研究在晚期CHF、慢性肾功能不全和贫血患者中，研究β-EPO对左心室（LV）收缩直径和容积（LVSD和LVSV）、LV舒张直径和容积（LVDD和LVDV）、LV质量、LV射血分数（LVEF）、肺动脉压（PAP）和B型利钠肽（BNP）水平的影响。
对51例连续的晚期CHF和贫血患者进行研究。我们进行了一项随机双盲对照研究，用皮下注射EPO纠正贫血4个月（A组，26例患者），对照组（B组，25例患者）用生理盐水作为安慰剂。然后在治疗组中继续进行EPO治疗8个月。两组在整个12个月期间均接受口服铁剂治疗。在4个月和12个月时报告超声心动图评估、BNP水平和血液学参数。
A组患者在双盲阶段（4个月）与基线相比以及与B组相比，LVEF增加，LVSD和LVSV轻度降低，PAP、LVDD和LVDV无差异。在12个月期间，A组血红蛋白从10.4±0.6增至12.4±0.8 g/dL（P<.01），而B组未改变。与B组相比，A组LVDD、LVSD、LVDV、LVSV、LV质量、PAP和BNP较低，LVEF较高。两组血清肌酐和肌酐清除率保持不变。
在CHF贫血患者中，与仅使用口服铁剂的对照组相比，用EPO和口服铁剂纠正贫血1年可改善LV收缩功能、LV重构、BNP水平和PAP。
