The Value Of Hemoglobin And Anemia In The Prognosis Of Patients With Chronic Heart Failure And Its Influencing Factors

Background:Chronic heart failure is a clinical syndrome with the decreased cardiac function a nd pump dysfunction caused by the basis for a variety of heart diseases, seriously aff ecting the quality of life of patients. In recent years, Great progress have been made i n the treatment of the underlying disease, such as the development of emergency PC Ⅰ、CABG、 the application of new anticoagulant antithrombotic drugs and other new t echnologies,which have reduced the mortality rate due to acute heart disease, and this part patients become the potential crowds who deteriorate into chronic heart failure i n the future, in recent years, the incidence of chronic heart failure is rising, and the mortality rate is also increasing, so a full understanding and treatment of heart failure has become a last front to save lives for cardiovascular specialist. Anemia has aroused the attention of clinicians as a common complication in patients with CHF, research i n anemia for prognosis of patients with CHF has had some results. Until now, with t he progress of Chinese medicine Objective Research, Clinically relevant indexes and c hronic heart failure prognosis based on TCM syndrome have achieved certain results. However, due to the complexity of CHF, clinical features changeable and heterogeneity of TCM differentiation method and syndrome stimation, which lead to less research o n the hemoglobin influence on CHF syndrome factors and prognosis.Therefore, this research will explore the value of hemoglobin and anemia on the prognosis of patients with CHF, and to explore the relevant clinical indicators with anemia and the TCM syndrome factors with prognostic value.Objective:To explore the prognosis value of hemoglobin and anemia for the patients with chronic heart failure and its influencing factorsMethods:Collected the patients,during January 2006 to August 2014 in Guang’anmen hospital c ardiovascular department, who has diagnosed as chronic heart failure patients with left ventricular ejection fraction (LVEF)<50% or NT-proBNP> 900pg/ml. Rule out acute myocardial infarction or acute heart failure, liver and other vital organs with failure, cardiogenic shock, fatal arrhythmias, atrioventricular block, uncontrolled hypertension,1 ung and kidney and endocrine system, the hematopoietic system and other serious pri mary disease, during hospitalization without the 24-hour ambulatory ECG evaluation, p regnant or lactating women, the researchers can not be completed with the relevant cli nical data entry and follow-up person, male or female, were collected 409 cases of pa tients. Review of medical records, general information collected during hospitalization, incidence, relevant medical history, related auxiliary inspection, laboratory exsanguinate assay result,clinical diagnosis and other data, the monthly patient clinic or telephone follow-up, access to endpoint (all-cause death) and its time. By plotting ROC curve to establish chronic heart failure in patients with hemoglobin and red blood cell groupin g criteria, adopting Kaplan-Meier-Survival-Analysis to explore its prognostic value in p atients with chronic heart failure, using Spearman correlation analysis to explore the re lated indexes of chronic heart failure with anemia.Results:(1) All-cause mortality of 409 cases patients with CHF was 28.6%, the distribution of the single syndrome elements show:blood stasis syndrome 277 cases (67.7%), qi defic iency syndrome 272 cases (66.5%), phlegm turbidity syndrome 189 cases (46.2%), yin deficiency syndrome 188 cases (46.0%), Yang deficiency syndrome 64 cases (15.6%); two syndrome factors (36.0%),and three syndrome factor combination (30%) are more common in multiple syndrome factor combination.(2) We adopt ROC curve to calculate the cut-off point of HGB and RBC, which is 1 10.5 g/L,4.025×1012/L. And then we grouping the HGB and RBC according to the cu t-off point. We adopt Kaplan-Meier-Survival-Analysis showed that lower HGB and RB C level representative a worse prognosis. The differences were statistically significant(p <0.01).(3) In the research on the relationship between the anemia level in patients with CHF and TCM Syndrome Factor. We have the conclusion that anemia level only related to qi deficiency Syndrome. The differences were statistically significant(p<0.05).(4) According to Spearman correlation analysis, the results showed that the degree of anemia in patients with CHF and gender, RBC count, low-density lipoprotein were pos itively correlated, In addition, with age, alanine aminotransferase, aspartate aminotransf erase, total bilirubin, direct bilirubin, indirect bilirubin, Creatinine, BUN, LVEF,high bl ood pressure were negatively correlated,and related indexes have statistical significanc e in the difference between the two groups.Conclusions:(1) The concentration of hemoglobin and red blood cells can be valued as an indepen dent predictor of chronic heart failure prognosis, when concentrations of the hemoglobi n is less than 110.5g/L or red blood cell less than 4.025×1012/L, the prognosis is wor se in patients with chronic heart failure.(2) Single syndrome elements distributions of patients with CHF from more to less w ere blood stasis syndrome (67.7%),qi deficiency syndrome (66.5%), phlegm turbidity s yndrome (46.2%), yin deficiency syndrome (46.0%),Yang deficiency syndrome (15.6%); two-syndrome factors combination (36.0%),and three syndrome factor combination (3 0%) are more common in multiple syndrome factor combination.(3) Single syndrome elements distributions of the CHF patients with anemia from mor e to less were:Qi deficiency syndrome> blood stasis syndrome> yin deficiency syn drome> phlegm turbidity syndrome> Yang deficiency syndrome, Qi deficiency and t he concentration of hemoglobin in chronic heart failure were negatively correlated(P< 0.05), the remaining single syndrome elements and level of anemia in patients with CHF was no significant correlation (P> 0.05); deficiency of qi and blood stasis is mo st common in two-syndrome factors combination, in this study, all two-syndrome facto rs combination were no significant correlation with the degree of anemia (P> 0.05).(4) With the increasing of the age, Cr, BUN, transaminases, bilirubin index, and the d ecreasing of the concentration of RBC, low density lipoprotein and LVEF, the hemogl obin level tends to be lower and the prognosis of the patient is much worse; anemia of CHF patients with hypertension were more serious; anemia of male CHF patients were more severe and Long-term prognosis was poor.