作者：亓琳1，苏南南1，张瑞2，秦浙学3，程菲2

单位：

1.271000山东省泰安市，解放军第九六〇医院泰安医疗区门急诊　2.100088北京市，火箭军特色医学中心急诊医学科3.400037重庆市，陆军军医大学第二附属医院心血管内科

单位（英文）：

1.Department of Outpatients and Emergency, Taian Medical District, No. 960 Hospital of Chinese PLA, Taian 271000, China2.Department of Emergency Medicine, Rocket Force Specialty Medical Center, Beijing 100088, China3.Department of Cardiovascular Medicine, Second Affiliated Hospital of Army Medical University, Chongqing 400037, China

关键词：

心力衰竭；铁缺乏；补铁治疗；作用机制；有效性；安全性；影响因素；综述

关键词（英文）：

Heart failure; Iron deficiency; Iron supplementation therapy; Mechanisms; Efficacy; Safety; Influence factors; Review

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2022.00.194

基金项目：

重庆市科卫联合医学科研项目（2022MSXM115）

摘要：

铁缺乏是心力衰竭患者常见的一种共患疾病。铁缺乏能引起心力衰竭患者运动能力、生活质量下降，住院及死亡风险增加。本文介绍了补铁治疗心力衰竭合并铁缺乏的机制、心力衰竭合并铁缺乏患者补铁治疗效果的影响因素、补铁治疗心力衰竭合并铁缺乏患者的安全性。分析表明，补铁治疗通过改善线粒体功能及细胞能量代谢，从而改善心力衰竭合并铁缺乏患者症状及生活质量，降低因心力衰竭入院风险。不同类型铁剂治疗效果不同，羧基麦芽糖铁治疗效果确切，异麦芽糖铁、葡萄糖酸钠铁、蔗糖铁等铁剂疗效尚有争议。提高补铁剂量、延长补铁治疗时间可能使患者获益更多。传统的口服铁剂吸收能力有限，而高生物利用度的新型口服铁剂有望为患者提供一种更便捷的补铁途径。理论上，铁缺乏程度越严重，补铁治疗效果越好，但如何全面、客观地评估心力衰竭患者铁缺乏程度有待进一步探讨。此外，补铁治疗心力衰竭合并铁缺乏患者是安全的。

英文摘要：

Iron deficiency is a common co-morbidity in patients with heart failure. Iron deficiency can impair exercisecapability, quality of life, and increase risk of hospitalization and mortality in heart failure patients. This article introduces themechanism of iron supplementation in the treatment of heart failure combined with iron deficiency, the influencing factors oftherapeutic effect of iron supplementation on patients with heart failure combined with iron deficiency, and the safety of ironsupplementation in patients with heart failure combined with iron deficiency. The analysis shows that iron supplementationimproves the symptoms and quality of life of patients with heart failure combined with iron deficiency by improving mitochondrialfunction and cellular energy metabolism, and reduces the risk of hospitalization for heart failure. The therapeutic effect of differentiron agents varies, ferric carboxymaltose is associated with a favorable treatment effect, while the effects of other iron agents, suchas iron isomaltoside, sodium ferric gluconate complex and iron sucrose are still controversial. Patients may benefit more fromincreasing the dose of iron supplementation and prolonging the duration of iron supplementation. Traditional oral iron agent isassociated with a limited absorption capacity, but novel oral iron agent with a higher bioavailability is expected to be a convenientroute to supplement iron. Theoretically, the more severe the iron deficiency, the better the effect of iron supplementation, but howto comprehensively and objectively evaluate the severity of iron deficiency in heart failure patients remains to be clarified. Inaddition, iron supplementation is safe for heart failure combined with iron deficiency patients.

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