背景:定量方法已显示出慢性心力衰竭(HF)患者的血容量(BV)谱具有临床上显着的异质性。患者性别如何影响这种体积异质性以及与心脏血液动力学的关系尚待定义。
方法:回顾性分析临床和定量BV,在三个医疗中心收集血浆容量(PV)和红细胞(RBC)质量数据.使用核医学I-131标记的血浆白蛋白指示剂稀释方法对BV进行定量,并在24小时内获得心脏血液动力学。
结果:在对149名男性和106名女性的分析中,男性的绝对BV平均更高(6.9±1.7vs.5.0±1.2升,p<0.001)然而,在两种性别中都显示出广泛的BV(2.9至14.5升)。男性与大的BV和PV扩张的患病率较高(>正常的25%)相关(36%vs.15%和51%与21%,分别,两者p<0.001)。相比之下,女性与正常总BV的患病率更高(44%vs.27%,p=0.005),PV(54%与27%,p<0.001),低血容量(23%vs.11%,p=0.005)和真正的贫血(42%vs.26%,p<0.001)。心脏血流动力学因性别而异,但在体积曲线和心脏充盈压之间仅显示出适度的关联。
结论:研究结果支持独特的血管内容积分布,反映了总BV的患病率和分布的性别差异,慢性HF患者的PV和RBC质量分布。这强调了将患者性别视为影响体积稳态的重要因素的重要性,需要将其考虑在内以有效地个性化体积管理策略。
BACKGROUND: Quantitative methods have shown clinically significant heterogeneity in blood volume (BV) profiles in patients with chronic heart failure (HF). How patients\' sex might impact this volume heterogeneity and its relationship to cardiac hemodynamics remains to be defined.
METHODS: Retrospective analysis of clinical and quantitative BV, plasma volume (PV) and red blood cell (RBC) mass data was undertaken across 3 medical centers. BV was quantitated using nuclear medicine I-131-labeled plasma albumin indicator-dilution methodology with cardiac hemodynamics obtained within 24 hours.
RESULTS: In an analysis of 149 males and 106 females, absolute BV was greater, on average, in males (6.9 ± 1.7 vs 5.0 ± 1.2 liters; P < 0.001); however, a wide range in BVs was demonstrated in both sexes (2.9-14.5 liters). Male sex was associated with higher prevalence of large (+ 25% of normal) BV and PV expansions (36% vs 15% and 51% vs 21%, respectively; both P < 0.001). In contrast, female sex was associated with higher prevalence of normal total BV (44% vs 27%; P = 0.005), PV (54% vs 27%; P < 0.001), hypovolemia (23% vs 11%; P = 0.005), and true anemia (42% vs 26%; P < 0.001). Cardiac hemodynamics differed by sex, but only modest associations were demonstrated between volume profiles and cardiac filling pressures.
CONCLUSIONS: Findings support unique intravascular volume profiles reflecting sex-specific differences in the prevalence and distributions of total BV, PV and RBC mass profiles in patients with chronic HF. This underscores the importance of recognizing patients\' sex as a significant factor influencing volume homeostasis, which needs to be taken into account to individualize volume-management strategies effectively.