蔗糖铁注射液治疗血液透析患者肾性贫血疗效观察

Effect of intravenous iron sucrose therapy in anemic hemodialysis patients

目的比较静脉用铁剂蔗糖铁(森铁能)与口服琥珀酸亚铁(速力菲)治疗血液透析患者肾性贫血的疗效与安全性。方法35例血透患者随机分为静脉组(19例)和口服组(16例)。静脉组:蔗糖铁100mg稀释于100ml生理盐水,每周使用1次,连续10次后,改为两周1次,共3月。口服组:琥珀酸亚铁200mg,每日3次,共3月。两组均使用EPO治疗,剂量为每周120～150U/kg,皮下或静脉应用。观察并比较两组患者贫血治疗的效果、铁代谢指标的变化及不良反应发生情况。结果治疗前静脉组与口服组基础情况无显著差异。治疗后两组Hb均较治疗前有明显升高(P<0.01),静脉组Hb上升幅度、速度均高于口服组(P<0.001)。静脉组Hct较治疗前明显升高(P<0.01),口服组无明显变化。两组Ret治疗前后无明显差异。两组SF治疗后明显升高(P<0.01),静脉组上升幅度较口服组明显(P<0.001)。静脉组TSAT治疗后明显上升(P<0.01),口服组上升不明显。两组治疗前后BUN、Scr、ALT、AST、ALP、TBIL、ALB等均无显著差异。CRP静脉组治疗后高于口服组,但其值在正常范围。静脉组无不良反应,口服组2例(12.5%)不良反应。结论静脉用蔗糖铁治疗肾性贫血安全有效,且不良反应低。

Objective To investigate the efficacy of intravenous iron sucrose therapy in anemic hemodialysis patients. Methods Thirty -Five maintenance hemodialysis patients were randomly divided into two groups： （1）Intravenous iron group（ Ⅳ group）. 100mg iron sucrose was intravenously pumped once a week during hemodialysis session, continued 10 times, then once two weeks. （2）Oral iron group （Oral group）. 200mg ferrous succinate three times a day for three months. Each patient of both groups received recombinent human erythropoetin （rHuEPO） treatment,120-150 U/kg every week. The efficacy was assessed by determining the subsequent change in Hb, ferritin , and transferring saturation values. Results There were no differences between intravenous and oral groups in sex, age, body weight, duration of hemodialysis, Hb values, ferritin and transferring saturation before treatment . At the end of the trial , the Hb levels in both groups significantly increased （P〈0.01）, but the Hb increment rate in Ⅳ group was markedly faster than that in oral group （P〈0.001） .The levels of Hct significantly increased in Ⅳ group （P〈0.01）, as that remained no change in oral group. Both of the Ret remained no change in two groups. The levels of ferritin significantly increased in both groups （P〈0.01）, but the ferritin increment rate in Ⅳ group was markedly faster than that in oral group （P〈0.001）. The levels of transferrin saturation significantly increased in Ⅳ group （P〈0.01） while remained no change in oral group. The serum levels of Scr, BUN , AST , ALP ,Alb and CRP in both groups did not change significantly. There were no severe adverse events in both groups , and the morbidity of adverse events in IV group was lower than that in oral group. Conclusion The intravenous iron sucrose is effective and safe in treating anemic hemodialysis patients with iron deficiency, and this treatment may induce Hb level to rise faster with less adverse events.