Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
Heart. 2012 Aug;98(16):1237-41. doi: 10.1136/heartjnl-2012-301954. Epub 2012 Jun 22.
Anaemia in heart failure (HF) is associated with a poor prognosis. Although inflammation is assumed to be an important cause of anaemia, the association between anaemia and inflammatory markers in patients with HF has not been well established.
Data from a multicentre randomised clinical trial, in which patients were eligible if they were >18 years of age and admitted for HF (New York Heart Association II-IV), were used. In a subset of 326 patients, haemoglobin (Hb), haematocrit, high sensitivity C-reactive protein (hsCRP), interleukin-(IL) 6, soluble tumour necrosis factor receptor (sTNFR)-1 and erythropoietin (Epo) were measured at discharge and the primary endpoint was all-cause mortality. Follow-up was 18 months.
Anaemia (Hb <13 g/dl (men) and <12 g/dl (women)) was present in 40% (130/326) of the study population. Median levels of IL-6, hsCRP and sTNFR-1 were significantly higher in anaemic patients than in non-anaemic patients. Logistic regression demonstrated that each increase in hsCRP values (OR 1.58 per SD log hsCRP; 95% CI 1.09 to 2.29; p=0.016) and each increase in sTNFR-1 values (OR 1.62 per SD log sTNFR-1; 95% CI 1.24 to 2.11; p<0.001) were independently associated with anaemia. Epo (HR 1.31 per log Epo; 95% CI 1.01 to 1.69; p=0.041) and sTNFR-1 (HR 1.47 per log sTNFR-1; 95% CI 1.16 to 1.86; p=0.001) levels were independently associated with outcome.
Anaemia is present in 40% of patients hospitalised for HF and is independently associated with inflammation.
心力衰竭（HF）伴发的贫血与预后不良相关。虽然炎症被认为是贫血的一个重要原因，但 HF 患者的贫血与炎症标志物之间的关系尚未得到充分确立。
使用多中心随机临床试验的数据，该试验的入选标准为年龄>18 岁且因 HF（纽约心脏协会 II-IV 级）入院的患者。在 326 例患者的亚组中，在出院时测量血红蛋白（Hb）、血细胞比容、高敏 C 反应蛋白（hsCRP）、白细胞介素（IL）-6、可溶性肿瘤坏死因子受体（sTNFR）-1 和促红细胞生成素（Epo），主要终点为全因死亡率。随访时间为 18 个月。
研究人群中存在贫血（Hb<13 g/dl（男性）和<12 g/dl（女性））的患者占 40%（130/326）。贫血患者的 IL-6、hsCRP 和 sTNFR-1 中位数水平明显高于非贫血患者。Logistic 回归表明，hsCRP 值每增加一个标准差（OR 1.58 per SD log hsCRP；95%CI 1.09 至 2.29；p=0.016）和 sTNFR-1 值每增加一个标准差（OR 1.62 per SD log sTNFR-1；95%CI 1.24 至 2.11；p<0.001）与贫血独立相关。Epo（HR 1.31 per log Epo；95%CI 1.01 至 1.69；p=0.041）和 sTNFR-1（HR 1.47 per log sTNFR-1；95%CI 1.16 至 1.86；p=0.001）水平与结局独立相关。
HF 住院患者中存在 40%的贫血，且与炎症独立相关。
