Статья
ДЕФИЦИТ ЖЕЛЕЗА И АНЕМИЯ У БОЛЬНЫХ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ
В статье рассматриваются проблемы дефицита железа и анемии при хронической сердечной недостаточности (ХСН). Представлен обзор литературы по эпидемиологии, этиологии и патогенезу анемии в этой категории больных. Приводятся различные опубликованные данные по влиянию анемии на прогноз ХСН. Обсуждается роль дефицита железа в развитии анемии, особенности его диагностики и влияния на течение ХСН. Автор объясняет роль различных железодефицитных синдромов в развитии анемии при указанной патологии, доказывает существенное преобладание смешанных форм дефицита железа, таких как железодефицитная анемия в сочетании с анемией хронической болезни, которые связаны не столько с абсолютным дефицитом железа, сколько с системной воспалительной реакцией. В статье описаны все существующие подходы к лечению дефицита железа и анемии у больных ХСН. Приводятся как положительные, так и отрицательные результаты использования классических пероральных препаратов железа, внутривенной ферротерапии, изолированного и сочетанного применения рекомбинантного человеческого эритропоэтина. Автор обсуждает причины неудач в лечении анемии и отсутствие выраженного влияния на клинические проявления ХСН при применении стандартных подходов в лечении. Как возможность более эффективной коррекции дефицита железа и анемии у больных ХСН, предлагаются новые препараты липосомального (сукросомального) железа для перорального применения. Приводятся последние, крайне обнадеживающие клинические результаты применения новой лекарственной формы при лечении дефицита железа и анемии у указанной группы больных.
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