静脉注射右旋糖酐氢氧化铁治疗肾性贫血疗效观察

Intravenous iron dextran treatment of anemia in chronic hemodialysis patients

目的:观察并比较静脉注射右旋糖酐氢氧化铁与口服琥珀酸亚铁治疗维持性血液透析(HD)患者铁缺乏的临床疗效及安全性。方法:选择44例慢性肾衰竭HD患者,随机分为静脉注射右旋糖酐氢氧化铁组(静脉组)与口服琥珀酸亚铁组(口服组),静脉组21例,口服组23例,总疗程8周。检测治疗前后血清铁、红细胞相关指标及生化指标,观察疗效及不良反应。结果:(1)共40例完成本研究,静脉组20例,口服组20例,两组患者年龄、性别、贫血程度、血清铁指标及基因重组红细胞生成素(rHuEPO)用量相当;(2)治疗8周后贫血均有改善,静脉组血红蛋白(Hb)上升(61.45±25.58)%,红细胞压积(HCT)上升(67.22±31.66)%,口服组Hb上升(31.77±13.37)%,HCT上升(34.41±21.81)%,静脉组显著高于口服组(P<0.001);(3)静脉组血清铁蛋白(SF)上升(272.38±502.54)%,口服组上升(186.78±304.55)%,静脉组转铁蛋白饱和度(TSAT)上升(45.6±33.6)%,口服组上升(11.4±12.11)%,静脉组明显高于口服组(P<0.001)。静脉组rHuEPO的用量低于口服组;(4)治疗8周后两组血清白蛋白升高,静脉组血肌酐下降,其他指标无改变。(5)静脉组有3例发生不良反应,1例出现低血压,退出实验,2例出现药物相关性皮疹,给予抗过敏后完成治疗;口服组9例出现明显的胃肠道反应,3例不能耐受退出。静脉组不良反应发生率为14.2%(3/21),口服组为39.1%(9/23),两组差异有统计学意义(P<0.001)。结论:静脉注射右旋糖酐氢氧化铁治疗肾性贫血疗效优于口服琥珀酸亚铁,且不良反应低,适合维持性血液透析患者铁缺乏的长期补铁的途径。

Objective： To evaluate the safety and efficiency of intravenous iron dextran in chronic hemodialysis patients. Methods： Forty-four HD patients were randomly dividied into 2 groups, 21 patients received intravenous iron dextran （IID）and 23 patients received oral iron （OI）, 8 weeks in total. Levels of serum ferritin （SF）, transferrin saturation （TSAT）, hemoglobin （Hb）, hematocrit （Hct） were tested before and - after the treatment . Results： At eight weeks, the levers of Hb, Hct, SF and TSAT were all increased in 2 groups,But all parameters in IID group were significantly higher than that in OI group （P〈0.001）. The level of serum albumin increased in 2 groups and serum creatine decreased in IID group. One case in IID occurred with lower blood pressure and two patients occurred with tetter,Nine patients in OI showed adverse gastrointestinal effects. The rate of side effect in IID 14. 2% （3/21） was significantly lower than in OI 39.1% （9/23） （P 〈0.001）. Conclusion： Intravenous iron dextran is better than oral iron in treatment of anemia in chronic hemodialysis, and the incident rate of adverse reaction is lower, So, it can be used for long period to HD patients with iron deficiency.