Clinical Cardiology, National Heart & Lung Institute, Imperial College London, London, United Kingdom.
J Am Coll Cardiol. 2011 Sep 13;58(12):1241-51. doi: 10.1016/j.jacc.2011.04.040.
The aim of this study was to comprehensively delineate iron metabolism and its implications in patients with chronic heart failure (CHF).
Iron deficiency is an emerging therapeutic target in CHF.
Iron and clinical indexes were quantified in 157 patients with CHF.
Several observations were made. First, iron homeostasis was deranged in anemic and nonanemic subjects and characterized by diminished circulating (transferrin saturation) and functional (mean cell hemoglobin concentration) iron status in the face of seemingly adequate stores (ferritin). Second, while iron overload and elevated iron stores were rare (1%), iron deficiency (transferrin saturation <20%) was evident in 43% of patients. Third, disordered iron homeostasis related closely to worsening inflammation and disease severity and strongly predicted lower hemoglobin levels independently of age, sex, erythrocyte sedimentation rate, New York Heart Association (NYHA) functional class, and creatinine. Fourth, the etiologies of anemia varied with disease severity, with an iron-deficient substrate (anemia of chronic disease and/or iron-deficiency anemia) evident in 16%, 72%, and 100% of anemic NYHA functional class I or II, III, and IV patients, respectively. Although anemia of chronic disease was more prevalent than iron-deficiency anemia, both conditions coexisted in 17% of subjects. Fifth, iron deficiency was associated with lower peak oxygen consumption and higher ratios of ventilation to carbon dioxide production and identified those at enhanced risk for death (hazard ratio: 3.38; 95% confidence interval: 1.48 to 7.72; p = 0.004) independently of hemoglobin. Nonanemic iron-deficient patients had a 2-fold greater risk for death than anemic iron-replete subjects.
Disordered iron homeostasis in patients with CHF relates to impaired exercise capacity and survival and appears prognostically more ominous than anemia.
本研究旨在全面描绘慢性心力衰竭（CHF）患者的铁代谢及其影响。
铁缺乏是 CHF 的一个新兴治疗靶点。
对 157 例 CHF 患者的铁和临床指标进行了定量分析。
观察到以下几点。首先，无论是否贫血，铁稳态均发生紊乱，表现为循环铁（转铁蛋白饱和度）和功能铁（平均红细胞血红蛋白浓度）状态下降，而储存铁（铁蛋白）似乎充足。其次，虽然铁过载和铁储存升高较为罕见（1%），但 43%的患者存在铁缺乏（转铁蛋白饱和度＜20%）。第三，铁稳态紊乱与炎症加重和疾病严重程度密切相关，并独立于年龄、性别、红细胞沉降率、纽约心脏协会（NYHA）功能分级和肌酐强烈预测血红蛋白水平降低。第四，贫血的病因随疾病严重程度而变化，NYHA 功能分级 I 或 II、III 和 IV 级贫血患者中分别有 16%、72%和 100%存在铁缺乏底物（慢性病贫血和/或缺铁性贫血）。尽管慢性病贫血比缺铁性贫血更为常见，但两种情况在 17%的患者中同时存在。第五，铁缺乏与峰值耗氧量降低和通气/二氧化碳产生比值升高相关，并且独立于血红蛋白，确定了那些死亡风险增加的患者（危险比：3.38；95%置信区间：1.48 至 7.72；p=0.004）。非贫血性缺铁患者的死亡风险是贫血性铁充足患者的 2 倍。
CHF 患者的铁稳态紊乱与运动能力受损和生存不良相关，且其预后比贫血更为严重。
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