静脉蔗糖铁治疗血液透析患者肾性贫血

Intravenous iron sucrose therapy in anemic hemodialysis patients

目的:比较静脉和口服铁剂分别联合应用基因重组人红细胞生长素(EPO)治疗伴有功能性缺铁的维持性血液透析患者贫血的疗效,探讨对功能性缺铁的补铁途径和方法。方法:将43例维持性血液透析存在功能性缺铁和贫血的患者分为静脉组和口服组。静脉组使用蔗糖铁注射液,口服组患者使用力蜚能。2组患者均联合EPO治疗,治疗3个月后观察病人血红蛋白(Hb)、红细胞(RBC)、红细胞压积(Hct)、血清铁蛋白(SF)、C反应蛋白(CRP)、维生素B12、肝肾功能的变化情况。结果:治疗前静脉组与口服组患者的性别、年龄、体重、接受治疗前维持透析时间及贫血程度、血清铁蛋白等差异无统计学意义。治疗结束时,静脉组Hb、RBC、SF均高于口服组(P<0.05)。2组平均EPO剂量差异无统计学意义。治疗后静脉组与口服组患者肝、肾功能、血清CRP、维生素B12等均无明显变化。结论:血液透析患者,若存在缺铁需静脉补铁。蔗糖铁注射液可更好地纠正患者的功能性缺铁,增加铁储备,改善EPO的疗效。

Objective： To compare the efficacy of intravenous iron sucrose with oral iron in rHuEPO-treated hemodialysis patients. Methods： Forty three chronic hemodialysis patients were divided into two groups： intravenous iron group （Iv group） and oral iron group （Oral group）. Each patient of both groups received recombinent human erythropoetin （rHuEPO） treatment for 3 months. Results： There were no difference between IV and oral group in sex, age, body weight, duration of hemodialysis, hemoglobin （Hb） values, ferritin before treatment. At the end of the trail the Hb levels, red blood cell （RBC） and serum ferritin （SF） in both groups significantly increased （P 〈0.05）. But the Hb increasement rate in IV group was markedly faster then that in oral group. There was no significant difference in average dosages of rHuEPO between two groups. The serum levels of Cr, BUN, AST, ALP, Alb and CRP in both groups did not change obviously in both groups. There were no severe adverse events in both groups. Conclusion： The intravenous iron sucrose is effective and safety in treating anemic hemodialysis patients with iron deficiency, and this treatment may induce Hb level to rise faster with less adverse events, and its amounts needed for patients can be evaluated more accurately than oral ferrous.