长期静脉补铁改善血液透析患者肾性贫血的作用

Effect of long-term intravenous iron supplementation on improvement of anemia in the patients with hemodialysis

目的探讨血液透析患者长期静脉补铁改善肾性贫血的效果以及对促红细胞生成素(EPO)作用的影响。方法选择56例病情稳定的血液透析患者随机分成两组:静脉组和口服组,各28例,疗程6个月。静脉组:于每次透析时补给100mg右旋糖酐铁,共10次,然后每2周给予维持量100mg。口服组:前3个月口服硫酸亚铁525mg/d,后3个月停服,按上述方法改用静脉补铁。比较两组贫血治疗效果、铁代谢和生化指标的变化、EPO用量以及不良反应发生情况。结果治疗后静脉组血红蛋白(Hb)、红细胞压积(Hct)、血清铁蛋白(SF)、转铁蛋白饱合度(TSAT)进行性升高,3个月后80%以上的患者贫血得到纠正,EPO用量较基数减少约28%。口服组治疗3个月时,Hb和Hct增幅不大,而SF和TSAT则逐月降低;第4个月起改用静脉补铁后,SF、TSAT很快升高,贫血迅速得到改善,EPO用量开始明显减少。结论长期静脉补铁不仅能及时有效地改善血液透析患者的贫血,减少EPO用量,而且经济、安全。

Objective To investigate the efficiency and safety as well as the effect of chronic intravenous iron supplementation on the improvement of anemia in the patients with maintain hemodialysis （MHD）. Methods Fifty - six patients with MHD were involved in the six - month, controlled trail and randomly divided into two groups ： intravenous iron group （ IV group） and oral iron group （ oral group）. The patients of IV group （n =28） were intravenously pumped 100 mg iron dextran during each hemodialysis session for the total amount of 1000 mg, after that, 100 mg iron dextrin each two weeks. Patients in the oral group took 525 mg ferrous sulfate a day during the first three months and received iron dextran on the above methods under stopping oral iron supplement during the second three months. The efficacy was assessed by determining the change of hemoglobin （Hb）, hematocrit （Hct）, serum ferritin （SF） and transferring saturation （TSAT）. Results The levels of Hb, Hct, SF, TSAT were increasing in the IV group after trail and there were evidently difference in those markers in the first three months, compared to the oral group, P 〈 0.05. Anemia in over 80% patients wa~ corrected and the dosages of erythropoientin（EPO） decreased by about 28% after three months of trail. Hb and Hct in the oral group increased slightly as well as SF and TSAT was decreasing, although the dosages of EPO gradually increased in the first three months. Anemia and SF, TSAT in the oral group were improved rapidly in the second three months of the trail after transferring to intravenous iron supplement. There were no severe adverse events in both groups and the morbidity of side effects in IV group was lower than that in oral group,P 〈0.05. Conclusion The chronic intravenous iron dextran not only improves the anemia in the patients with MHD and reduces the usages of EPO, but also safe and economic with less adverse effects.