| Background and ObjectivesHeart failure is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. It is not only the destination of majority of cardiovascular diseases, but also the major cause of cardic death. And the prevalence is worldwide high. The prevalence is0.9%in China. While in America, studies have shown that500million patients are suffering heart failure, and the prevalence is increasing year by year. Five year mortality rate would be50%, and one year mortality rate could even be50%in some serious heart failure patients. The basic mechanism of the chronic of heart failure is myocardial remodeling. Myocardial damage increased excitability of the sympathetic nervous system and the renin-angiotensin-aldosterone system, and then activated a variety of endogenous neuroendocrine factors and cytokines. Since the treatment of chronic heart failure has shifted from improving hemodynamic to blocking overactivated neuroendocrine system and biological therapy the pharmacotherapy of CHF has made great progress, but CHF is still an important reason for hospitalization and death in the elderly.CHF is known to be a complex clinical syndrome which could affect some organs. Recent studies showed that a number of aged patients with chronic heart failure (CHF), chronic kidney disease (CKD) also suffered anemia, and Anemia had relation with the degree of heart failure, increased mortality rate and re-hospitalization rate, decreased activity ability and life quality. And renal dysfunction always exists in CHF patients. CHF、CKD and anemia can interacted each other, resulting a vicious circle, which was called cardio renal anemia syndrome. Therefore, if renal dysfunction and anemia were improved, the prognosis of heart failure may be better.This study aims to expose the relationship among heart function, anemia and chronic renal insufficiency through a retrospective study on112elderly male CHF patients who were in different heart function, and to analyse the effect of anemia on heart&renal function.Object and methodRandomly select112male CHF patients over60who were admitted in hospital from December,2010to December,2011. Then analyzed the basic clinical features of their debut, measured and the experimental indexes including left ventricular end diastolic diameter (LVEDd), left ventricular ejection fraction (LVEF), NT-proBNP, serum creatinine (SCr), and blood test and calculate the glomerular filtration rate (GFR). According to NYHA heart function ratings, they were classified into groups:44with NYHAⅡ,35with NYHAⅢ, and33with NYHAIV. The control group consists of21healthy elder people, randomly selected. Under the standards recommended by World Health Organization:hemoglobin (Hb)<120g/L suggested anemia, and patients were divided into anemia group and non-anemia group,56and77respectively, and there was no age gap (P>0.05). SPSS17.0statistical software were used for statistical analysis..P<0.05showed that the difference was statistically significant.Result1. Comparison of anemia rates among healthy group and groups of different CHF degreeThe control group, NYHA class Ⅱ, Ⅲ, Ⅳlevel groups’prevalence of anemia were14.3%,25.0%,54.3%and69.7%respectively. The comparison between any two groups found that healthy control group with NYHA class Ⅱ was no statistically significant (P>0.05), NYHA class Ⅲ group with NYHA class Ⅳ group was no statistically significant (P>0.05), other groups were statistically significant (P <0.05).2. Comparison of heart function and hematological indexes among groups and the control groupThe control group, NYHA class Ⅱ, Ⅲ, Ⅳ level groups’ LVEDd(mm) were (43.0±3.7vs48.1±5.1vs53.2±8.6vs63.1±10.0; P<0.05, Respectively); LVEF(%) were (63.86±4.6vs59.79±5.9vs48.9±7.7vs36.5±8.9; P<0.05, Respectively); NT-proBNP(pg/mL) were (79.9±68.7vs523.5±351.7vs1667.1±1008.2vs5796.8±3993.0; P<0.05, Respectively).3. Comparison of hematological indices and renal function indicators among groups and the control groupThe control group, NYHA class Ⅱ, Ⅲ, Ⅳ level groups’ RBC (×109) were (4.4±0.6vs4.1±0.4vs3.9±0.6vs3.7±0.4; P<0.05, Respectively); Hb(g/L) were (136.0±18.3vs128.1±11.5vs115.5±14.2vs107.6±20.6; P<0.05, Respectively); HCT(%) were (40.1±5.8vs39.1±3.7vs34.9±4.1vs35.4±5.7; P<0.05, Respectively); SCr(mmol/L) were (70.0±11.3vs73.4±13.1vs96.4±45.4vs90.7±55.6; P>0.05, Respectively); GFR(ml·min·(1.73m2)-1) were (90.1±27.4vs83.829.2vs79.9±30.7vs62.1±28.1; P<0.05, Respectively)。4. Comparison of heart and renal functions between anemic group and non-anemic groupAnemia group’ LVEDd(mm) was higher than the non-anemia group (55.4±10.8vs50.0±9.0, P <0.05); LVEF(%) was lower (46.7±11.8vs55.7±11.5, P <0.05), NT-proBNP(pg/mL) level was higher than non-anemic group (3485.4±3770.9vs943.8±1542.2, P <0.05), GFR(ml-min-(1.73m2)-1) was also lower than non-anemia group (68.9±32.4vs85.9±26.4, P <0.05). SCr(mmol/L) was higher (88.7±45.1vs78.8±36.6), but no statistical significance (P>0.05).5. Linear correlation analysis among the heart, renal functions and anemia indicatorsThe linear correlation analysis showed: the hemoglobin showed negative correlation with LVEDd and NT-proBNP (r=-0.338,-0.539; P<0.05, Respectively), and positive correlation with LVEF and GFR (r=0.440,0.324; P<0.05, Respectively); GFR was positive correlation with RBC, Hb, HCT(r=0.365,0.324,0.255; P<0.05, Respectively), and negative correlation with NT-proBNP(r=-0.343;.P<0.05); NT-proBNP was negative correlation with RBC, Hb, HCT and GFR(r=-0.305,-0.539,-0.370,-0.343; P<0.05, Respectively), and positive correlation with SCr (r=0.319, P<0.05)。6. Comparison of anemia indicators between anemia group and non-anemia groupCompared with the non-anemia group, anemia group’RBC count (×109) was lower (3.7±0.5vs4.4±0.5; P<0.05), HCT(%) was lower (33.6±4.0vs40.2±3.8; P<0.05); MCH(pg) was lower (29.6±3.0vs30.9±2.5; P<0.05), MCHC(g/L) was also lower(321.2±15.3vs331.6±14.3; P<0.05), MCV(fL) was higher, but has no statistical significance(91.9±6.9vs92.8±4.7;P>0.05); RDW(%) was higher (47.1±7.5vs44.3±5.8; P<0.05)。Conclusion1. With the aggravation of chronic heart failure, anemia and renal function are deteriorating.2. Compared with non-anemia patient, the patients with anemia’heart and renal function are worse.3. Heart failure, renal failure and anemia are interrelated and aggravating each other. |
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