蔗糖铁治疗维持性血液透析患者不安腿综合征的临床观察

Effects of saccharum iron on restless legs syndrome in maintenance hemodialysis patients

目的通过观察静脉注射蔗糖铁对维持性血液透析(maintenance hemodialysis,MHD)患者不安腿综合征(restless legs syndrome,RLS)评分的变化,探讨蔗糖铁治疗MHD患者RLS的临床疗效。方法①选择在上海市闸北区中心医院血液净化中心透析龄超过3个月的MHD患者40例,经问卷调查确诊有RLS,诊断采用RLS国际研究小组制定的标准并进行评分。②随机分为治疗组20例,对照组20例,治疗组静脉滴注蔗糖铁100mg/次,每周1次,连续用药10周,总量1000mg;对照组不用蔗糖铁以及其他铁剂。③分别观察两组患者在治疗前、治疗后4、8、10周的血红蛋白(Hb)、血清铁(Fe)、血清铁蛋白(SF)、总铁结合力、转铁蛋白饱和度(TSAT)水平的变化,同时观察患者RLS评分及药物不良反应等。结果①两组患者治疗前Hb、Fe、SF、总铁结合力、TSAT无统计学意义(P>0.05)。②治疗组随着治疗时间延长,Fe、SF、TSAT逐渐升高,治疗后4周较治疗前明显上升、且治疗后10周上升更为明显(P<0.05,P<0.01);而总铁结合力较治疗前逐渐降低、治疗后10周下降更为明显(P<0.05,P<0.01);分别与同期对照组比较,有统计学意义(P<0.05,P<0.01);对照组上述指标治疗前后无明显变化(均P>0.05)。③治疗前、治疗后4、8、10周的RLS评分,治疗组和对照组比较:治疗前为[(16.29±10.08]与(15.79±10.42)](P>0.05);第4周为[(14.02±9.18)与(16.03±10.42)](P<0.05);第8周为[(10.94±9.03)与(15.12±9.34)](P<0.01);第10周为[(10.02±8.14)与(14.97±10.13)](P<0.01);④治疗组未发生药物不良反应。结论不安腿综合征(RLS)是MHD患者常见的并发症之一,铁缺乏与RLS的发生发展有关。MHD患者常合并铁缺乏,在补铁治疗后,患者铁贮备明显升高、RLS评分亦明显下降,对治疗RLS取得一定的疗效。

Objective To observe the effects of saccharum iron on restless legs syndrome(RLS) in maintenance hemodialysis(MHD) patients.Methods We recruited 40 patients who underwent hemodialysis for at least three months before the study and with restless legs syndrome(RLS).RLS was diagnosed according to the criteria from the International Restless Legs Syndrome Study Group(IRLSSG).These patients were randomly divided into two groups,treatment group(20 cases) and control group(20 cases).In the treatment group,100mg of saccharum iron were infused to the patient during the dialysis treatment once a week with a total dose of 1000 mg,while in the control group no iron preparations were used.Hemoglobin(Hb),serum Fe(Fe),serum ferritin(SF),transferrin saturation(TSAT) and RLS rating scale were determined every four weeks during the treatment.Side-effects of the drug were also recorded.Results At the initiation of the investigation,there were no significant differences in Hb,Fe,SF,TSAT and RLS rating scale between the two groups.After the treatment for 10 weeks,Fe,SF and TSAT increased significantly compared with those before treatment(P < 0.05 or P < 0.01) in the treatment group,but changed insignificantly in the control group(P > 0.05).RLS rating scale was 16.29 ± 10.08 and 15.79 ± 10.42 before the treatment(P > 0.05),14.02 ± 9.18 and 16.03 ± 10.4 after the treatment for 4 weeks(P<0.05),10.94 ± 9.03 and 15.12 ± 9.34 after the treatment for 8 weeks(P < 0.01),and 10.02 ± 8.14 and 14.97 ± 10.13 after the treatment for 10 weeks(P < 0.01) in the treatment group and control group,respectively.No significant side-effects were found in the treatment group.Conclusion Intravenous supplement of saccharum iron appears to be associated with the improvement of RLS in MHD patients.