贫血可加速心衰患者的肾功能减退
Anemia Linked to a Rapid Decrease in Kidney Function in Heart Failure贫血可加速心衰患者肾功能减退
NEW YORK (Reuters Health) May 18 - Results of a study published in the April 15th issue of the American Journal of Cardiology indicate that anemia is a risk factor for kidney function decline in patients with heart failure, especially in those with underlying chronic kidney disease.
纽约(路透社健康版)5月18日电，刊登在4月15日发行的美国心脏病杂志上的一项研究表明，贫血对于心衰肾功能衰退患者是一种危险因素，尤其是那些患有慢性肾脏病的心衰患者。
Dr. Mark J. Sarnak, of Tufts-New England Medical Center, Boston, Massachusetts, and colleagues performed a secondary analysis of data from the Studies of Left Ventricular Dysfunction (SOLVD) trial, a randomized trial of enalapril versus placebo in patients with decreased ejection fractions.
马萨诸塞州波士顿塔夫茨新英格兰医学中心，Dr. Mark J. Sarnak,和其同事们对研究左心功能不全(SOLVD)试验的数据运行了中等分析，(SOLVD)试验是射血分数减退患者使用依那普利与安慰剂对照的一个随机化试验。
Following randomization, creatinine measurements were taken at 2 weeks, 6 weeks, 4 months, and every 4 months thereafter. A rapid decrease in kidney function was defined as a decrease in estimated glomerular filtration rate (GFR) of at least 6 mL/min per 1.73 m per year. Anemia was defined as a baseline hematocrit of less than 36%.
遵循随机化原则，肌酐分别采取自2个星期，6个星期，4个月。以后每4个月. 肾脏功能的快速减退被界定为一种评估肾小球滤过率(GFR)的下降，至少为6毫升/每分钟1.73米左右。贫血是指作为红细胞容积基线低于36%.
A total of 6360 subjects, mean age of 59 years, were included in the study. Overall, 31% of subjects had chronic kidney disease (CKD), defined as baseline GFR no greater than 60 mL/min per 1.73 m, and 6% had anemia.
总共6360例受试者，平均年龄59岁，均被纳入研究范围。整体而言，31%的受试者有慢性肾脏疾病(CKD)，界定为肾小球滤过率(GFR)基线不大于60毫升/每分钟1.73米，和6%有贫血。
The median follow-up time was 2 years.
随访中位数时间为2年.
In multivariate analysis, the investigators found that subjects with anemia were 30% more likely to have a rapid decrease in kidney function than those without anemia. "This relation was modified by the level of kidney function," Dr. Sarnak's team reports. "In subjects with CKD, the odds of rapid decrease in GFR were 71% greater in those with anemia, whereas in subjects without CKD, the odds of rapid decrease in GFR were only 16% greater."
Dr. Sarnak's 团队报道，用多元统计分析调查发现，贫血病受试者中的30%对比没有贫血的受试者更有可能导致肾功能的急剧下降。"这种关系受到肾脏功能水平的限制，""慢性肾脏功能不全的受试者，肾小球滤过率(GFR)下降的概率是71％，大于有贫血的受试者，而在没有慢性肾脏功能不全的受试者中，肾小球滤过率(GFR)下降的概率只有16%多。"
The researchers say that, "curiously," ACE inhibition did not protect against the progression of kidney impairment, possibly because of the low prevalence of proteinuric kidney disease in the cohort. "In addition, the use of ACE inhibitors is associated with anemia, and it is possible that the exacerbation of anemia may also contribute to the absence of a protective effect against kidney disease progression with ACE inhibitor use."
研究人员说，"令人奇怪的是，" ACE（血管紧张素转化酶）抑制剂并能不保护治疗肾功能受损进程， 可能因为在这一群体中蛋白尿肾脏疾病发病率低。"此外，使用ACE抑制剂能并发溶血性贫血，也有可能贫血的恶化导致使用ACE抑制剂治疗肾脏疾病进程中保护效应的缺失。"
Am J Cardiol 2007;99:1137-1142.
美国心脏病学杂志。2007；99：1137－1142。
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