铁代谢在心力衰竭中的研究进展

Research Progress in Iron Metabolism in Heart Failure

摘要: 铁是人体必要的微量元素，它对生命体中几乎所有类型的细胞都是必不可少的；铁稳态对人体至关重要，铁的缺乏和过量对人体是有害的，可导致患者发生心力衰竭。因此，必须严格控制铁稳态，以防止缺铁导致贫血以及铁过量使游离铁的产生和活性氧的增加，致组织损伤和器官衰竭。铁调素在调节铁代谢中起着重要的作用，是脊椎动物全身性铁稳态的关键调节剂，当铁调素水平升高时，铁被困在十二指肠肠细胞、肝细胞、脾巨噬细胞及胎盘合胞滋养细胞内，导致血浆铁水平下降。心肌细胞铁调素是自主细胞铁稳态所必需的，心脏铁调素的功能不仅限于调控铁水平，同时也具有抗心肌细胞凋亡、抗心肌肥大和抗心肌纤维化作用。HF患者ID发生率较高，有研究表明对HF患者静脉补充铁剂治疗ID可改善其运动能力和生活质量，连续静脉补铁12周后可减少HF的住院率，口服铁补充剂不能提高运动能力和生活质量，但它们可以减少全因死亡和心力衰竭住院率，但口服铁制剂的胃肠道副作用发生率很高，可能导致胃肠道吸收不良、胃肠道溃疡穿孔、饮食不良或乳糜泻等，此外，铁调素的上调也会减少膳食铁的吸收，因此，目前推荐静脉补充铁剂来治疗HF。

Abstract: Iron is an essential trace element for the human body, it is essential for almost all types of cells in the living body. Iron homeostasis is essential for the human body. Iron deficiency and excess are harmful to the human body and can lead to heart failure in patients. Therefore, iron homeostasis must be strictly controlled to prevent anemia due to iron deficiency and the increase of free iron production and reactive oxygen species due to iron overdose, leading to tissue damage and organ failure. Hepcidin plays an important role in regulating iron metabolism and is a key regulator of systemic iron homeostasis in vertebrates. When hepcidin levels are elevated, iron is trapped in duodenal cells, hepatocytes, splenic macrophages, and placental syncytial trophoblasts, resulting in a decrease in plasma iron levels. Cardiomyocyte hepcidin is required for iron homeostasis in autonomous cells, and the function of cardiac hepcidin is not limited to regulating iron levels, but also has the effects of anti-cardiomyocyte apoptosis, anti-myocardial hypertrophy, and anti-myocardial fibrosis. Patients with HF have a higher incidence of ID, studies have shown that intravenous iron treatment with ID improves exercise capacity and quality of life in patients with HF, reduces hospitalization of HF after 12 weeks, oral iron supplementation does not improve exercise capacity and quality of life, but they can reduce all-cause mortality and heart failure hospitalization. However, oral iron preparations have a high incidence of gastrointestinal side effects that may lead to gastrointestinal malabsorption, perforation of gastrointestinal ulcers, poor diet, or celiac disease. In addition, the upregulation of hepcidin also reduces the absorption of dietary iron. Therefore, intravenous iron is currently recommended for HF.