Department of Cardiovascular Medicine, Yuechi County People's Hospital, Guang'an, China.
Geriatric Diseases Institute of Chengdu / Cancer Prevention and Treatment Institute of Chengdu, Department of Cardiology, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China.
ESC Heart Fail. 2022 Oct;9(5):2779-2786. doi: 10.1002/ehf2.14020. Epub 2022 Jun 27.
AIMS: This review aimed to assess whether oral iron supplementation in a chronic heart failure (HF) population with iron deficiency (ID) or mild anaemia is safe and effective according to evidence-based medicine. METHODS: We retrieved 1803 records from the PubMed, Embase, and the Cochrane Library databases from 1 January 1991 to 15 September 2021. The clinical outcome of oral iron supplementation for ID anaemia in patients with HF was the primary endpoint. The primary safety measures included adverse events and all-cause mortality, and efficacy measures included transferrin saturation (Tsat), ferritin levels, and the 6-min walk test (6MWT). The rate ratio (RR) was used to pool the efficacy measures. RESULTS: Five randomized controlled trials that compared oral iron treatment for patients with the placebo group and included a combined total of 590 participants were analysed. No significant difference was found in all-cause death between oral iron treatment and placebo groups (RR = 0.77; 95% confidence intervals (CI), 0.46-1.29, Z = 0.98; P = 0.33). However, adverse events were not significantly higher in the iron treatment group (RR = 0.83; 95% CI, 0.60-1.16, Z = 1.07; P = 0.28). In addition, ferritin levels and Tsat were slightly increased after iron complex administration in patients with HF but were not statistically significant (ferritin: mean difference [MD] = 2.70, 95% CI, -2.41 to 7.81, Z = 1.04; P = 0.30; Tsat: MD = 27.42, 95% CI, -4.93 to 59.78, Z = 1.66; P = 0.10). No significant difference was found in exercise capacity, as indicated by the 6MWT results (MD = 59.60, 95% CI, -17.89 to 137.08, Z = 1.51; P = 0.13). We also analysed two non-randomized controlled trials with follow-up results showing that oral iron supplementation increased serum iron levels (MD = 28.87, 95% CI, 1.62-56.12, Z = 2.08; P = 0.04). CONCLUSIONS: Based on the current findings, oral iron supplementation can increase serum iron levels in patients with HF and ID or mild anaemia but does not improve Tsat and 6MWT. In addition, oral iron supplementation is relatively safe.
目的：本综述旨在根据循证医学评估慢性心力衰竭（HF）伴缺铁（ID）或轻度贫血患者口服铁补充剂的安全性和有效性。
方法：我们从 1991 年 1 月 1 日至 2021 年 9 月 15 日检索了 PubMed、Embase 和 Cochrane Library 数据库中的 1803 条记录。HF 患者 ID 性贫血口服铁补充的临床结局是主要终点。主要安全性措施包括不良事件和全因死亡率，疗效措施包括转铁蛋白饱和度（Tsat）、铁蛋白水平和 6 分钟步行试验（6MWT）。使用率比值（RR）对疗效措施进行汇总。
结果：分析了 5 项比较口服铁治疗与安慰剂组的随机对照试验，共纳入 590 名患者。口服铁治疗组与安慰剂组之间的全因死亡无显著差异（RR = 0.77；95%置信区间（CI），0.46-1.29，Z = 0.98；P = 0.33）。然而，铁治疗组的不良事件发生率并没有显著升高（RR = 0.83；95%CI，0.60-1.16，Z = 1.07；P = 0.28）。此外，铁复合物治疗后 HF 患者的铁蛋白水平和 Tsat 略有升高，但无统计学意义（铁蛋白：平均差[MD] = 2.70，95%CI，-2.41 至 7.81，Z = 1.04；P = 0.30；Tsat：MD = 27.42，95%CI，-4.93 至 59.78，Z = 1.66；P = 0.10）。6MWT 结果表明，运动能力无显著差异（MD = 59.60，95%CI，-17.89 至 137.08，Z = 1.51；P = 0.13）。我们还分析了两项非随机对照试验的随访结果，表明口服铁补充剂可增加血清铁水平（MD = 28.87，95%CI，1.62-56.12，Z = 2.08；P = 0.04）。
结论：根据目前的发现，口服铁补充剂可增加 HF 伴 ID 或轻度贫血患者的血清铁水平，但不能改善 Tsat 和 6MWT。此外，口服铁补充剂相对安全。
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