Heart failure and anemia: mechanisms and pathophysiology
Heart failure and anemia: mechanisms and pathophysiology
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DOI：
10.1007/s10741-008-9088-8
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发表时间：
2008-12-01
影响因子：
4.6
通讯作者：
Anand, Inder S.
中科院分区：
文献类型：
--
作者：
Anand, Inder S.
贫血是心力衰竭患者的常见合并症，根据所用的贫血定义和研究人群，影响高达50%的患者。贫血和血红蛋白（Hgb）浓度降低是心力衰竭不良结局的有力独立预测因素。即使是Hgb的微小降低也与更差的结果相关。纠正贫血可能有助于改善心力衰竭结局。然而，心力衰竭贫血的原因并不完全清楚。贫血的特殊原因如血液异常仅见于少数受试者。肾功能不全和神经激素和促炎细胞因子激活似乎有助于在大多数患者的慢性疾病贫血，导致不适当的促红细胞生成素的生产和铁的利用缺陷。在正常情况下，由于慢性贫血导致的组织氧合减少导致非血液动力学和血液动力学代偿反应，以增强携氧能力。红细胞生成是对缺氧的主要非血流动力学反应，但由于心力衰竭时红细胞生成缺陷，血流动力学机制占主导地位。血流动力学反应是复杂的，涉及血管舒张介导的高输出状态与神经激素激活。高输出状态最初有助于增加氧气输送。然而，血液动力学和神经激素的改变可能会产生有害的长期后果，并可能导致贫血作为不良结局的独立风险因素。
Anemia is a common comorbidity in patients with heart failure and affects up to 50% of patients, depending on the definition of anemia used and on the population studied. Presence of anemia and lower hemoglobin (Hgb) concentrations are powerful independent predictors of adverse outcomes in heart failure. Even small reductions in Hgb are associated with worse outcomes. Correction of anemia may be useful in improving heart failure outcomes. However, the causes of anemia in heart failure are not entirely clear. Specific causes of anemia such as hematinic abnormalities are seen only in a minority of subjects. Renal dysfunction and neurohormonal and proinflammatory cytokine activation appear to contribute to anemia of chronic disease in the majority of the patients, resulting in inappropriate erythropoietin production and defective iron utilization. Under normal conditions, reduced tissue oxygenation due to chronic anemia results in non-hemodynamic and hemodynamic compensatory responses to enhance oxygen carrying capacity. Erythropoiesis is the predominant non-hemodynamic response to hypoxia, but because erythropoiesis is defective in heart failure, hemodynamic mechanisms predominate. Hemodynamic responses are complex and involve a vasodilation-mediated high-output state with neurohormonal activation. The high-output state initially helps to increase oxygen transport. However, the hemodynamic and neurohormonal alterations could potentially have deleterious long-term consequences and could contribute to anemia's role as an independent risk factor for adverse outcomes.