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目的:探讨慢性心力衰竭(CHF)患者血清铁水平与心脏功能及预后的关系。方法:选取住院治疗的CHF患者178例,根据入院时的血清铁水平将患者分为正常组与铁缺乏组,采用心脏超声检测计算左室射血分数(LVEF),应用6min步行试验评估运动耐力。随访6个月,统计心脏不良事件(死亡、心力衰竭、再次入院、脑卒中或急性冠脉综合征)发生率。结果:铁缺乏组心力衰竭症状显著加重,N末端脑钠肽前体(NT-proBNP)水平增加,而LVEF值及6min步行距离低于正常组。相关性分析发现,铁缺乏组血清铁、血清铁蛋白水平均与NTproBNP和心功能分级呈负相关,与6min步行距离和LVEF呈正相关。6个月随访发现:铁缺乏组心力衰竭发生率及再入院率显著增高,但病死率、脑卒中及急性冠脉综合征发生率无统计学差异。结论:血清铁缺乏对心力衰竭程度及临床预后判断具有重要意义。
Objective: To investigate the relationship between serum iron level and cardiac function and prognosis in patients with chronic heart failure (CHF). Methods: A total of 178 hospitalized CHF patients were enrolled in this study. Patients were divided into normal group and iron deficiency group according to serum iron level at admission. Left ventricular ejection fraction (LVEF) was calculated by echocardiography, and exercise tolerance was assessed by 6-minute walk test . The patients were followed up for 6 months and the incidence of cardiac adverse events (death, heart failure, re-admission, stroke or acute coronary syndrome) was calculated. Results: The symptoms of heart failure in the iron deficient group were significantly aggravated. The levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) increased, while the LVEF and 6-minute walking distance were lower than those in the normal group. Correlation analysis showed that serum iron and serum ferritin levels were negatively correlated with NTproBNP and cardiac function in iron deficiency group, and were positively correlated with 6min walk distance and LVEF. At 6-month follow-up, there was a significant increase in the incidence of heart failure and readmission in the iron deficiency group, but there was no significant difference in the incidence of death, stroke and acute coronary syndrome. Conclusion: Serum iron deficiency is of great significance for the degree of heart failure and clinical prognosis.