口服与静脉铁剂治疗血液透析患者贫血的疗效观察

Effect of intravenous and oral iron in the patients undergoing maintenance hemodialysis

目的比较维持性血液透析患者口服和静脉补铁治疗肾性贫血的疗效,以及对促红细胞生成素(EPO)作用的影响。方法将30例病情稳定的血液透析患者随机分成静脉组和口服组2组各15例,观察期6个月。口服组口服福乃得(含硫酸亚铁525mg)1片/天,静脉组静脉补充铁剂。先按公式在2周内给予负荷剂量,以后每2周给予维持量100mg。若患者的血红蛋白(Hb)达到目标值120g/l,则将EPO的剂量减少25%。结果治疗后两组患者的Hb、红细胞压积(Hct)、铁蛋白(SF)和转铁蛋白饱和度(TSAT)进行性升高,治疗后3个月时口服组和静脉组患者的Hb、Hct、SF和TSAT均较治疗前显著升高,而静脉组升高的幅度明显高于口服组(P<0.01)。透析患者的贫血得到纠正,EPO用量开始减少,同时SF和TSAT保持在较高水平。6个月时EPO用量开始明显减少,减少的幅度明显高于口服组(P<0.01),明显高于治疗前静脉组(P<0.01)。结论长期静脉补铁不仅能及时有效地补充慢性肾衰竭血透患者贫血所需的铁剂,使贫血状况改善,而且能减少EPO用量。

Objective To compare the efficiency of intravenous and oral iron and influence of erythropoietin （EPO） in the patients undergoing maintenance hemodialysis. Methods Thirty stable patients with MHD were involved in the six-month, controlled trial and randomly divided into two groups：intravenous iron group （ Ⅳ group） and oral iron group （ oral group）. Patients in the oral group took 525mg ferrous sulfate every day. The patients of Ⅳ group （n = 15） were intravenously pumped 100rag iron dextran each two weeks under the reducing or stable of the dosages of EPO. Results There were no differences between two groups in age, sex, body weight, duration of HD, the dosages of EPO, Hb, Hct, SF,TSAT and so on before trial. The levels of Hb,Hct,SF,TSAT were increasing in two groups after trail and there were significant difference in those markers after three months,compared to the oral group, （P 〈0.01 ）. Anemia in patients was corrected and the dosages of EPO decreased and SF,TSAT were maintained in high level, The dosages of EPO decreased rapidly, compared to the oral group and intravenous iron group before trial （P 〈0.01 ）. Conclusion The chronic intravenous iron dextran not only supplies the iron to patients with MHD for correcting anemia but also reduce the usages of EPO.