静脉与口服铁剂对肾性贫血的临床观察

Clinical Observation of Oral Taking Iron Preparation on Vein of Renal Anemia

[目的]观察慢性肾功能不全患者静脉和口服补铁治疗肾性贫血的疗效、不良反应的发生情况以及对促红细胞生成素(EPO)使用效应的比较。[方法]将我院2006.11—2007.10期间病情稳定的48例肾性贫血患者随机的分为静脉组和口服组2组,每组24例,观察期10周。所有患者均常规使用EPO治疗,剂量为100U/kg·w,皮下注射,若患者血红蛋白(Hb)达10g/dl则将EPO剂量减少50%,若患者HB达12g/dl则将EPO剂量减少75%。观察用药前、用药后4周、用药后8周、用药后10周的Hb、红细胞压积(Hct)、铁蛋白(SF)、不良反应以及应用EPO剂量。[结果]治疗后两组患者的Hb、Hct、SF均较治疗前有明显升高,而静脉组升高幅度显著于口服组(P<0.01),两组患者应用EPO的剂量在治疗后较治疗前均有所减少,而静脉组减少明显(P<0.05),静脉组不良反应的发生率明显低于口服组,EPO的效应明显高于口服组。[结论]静脉补铁不仅能及时有效地补充肾性贫血患者所需的铁剂,使贫血状况改善,不良反应少,可安全应用,而且能增强EPO效应,减少其用量。

[Objective] To compare the therapeutic effects and adverse reactions between intravenous and oral iron, and the effects of erythropoietin （EPO） in patients with chronic renal failure. [Methods] Between November, 2006 and October, 2007,48 patients with renal anemia were randomized into 2 groups： intravenous group and oral group,24 in each. The duration of administration lasted for 10 weeks. All patients received regular EPO,with the dose of 100U/kg/week. If the patient＇s hemoglobin （Hb） was more than 10g/dl, then the dose of EPO decreased by 50 %. If the patient＇s Hb was more than 12g/dl, then the dose decreased by 75 %. The levels Of H b, hematocrit,serum ferritin, adverse reaction and dose of EPO before and 4 weeks,8 weeks and 10 weeks after the administration were observed. [Results] The levels of Hb, Hct and SF in both groups after administration increased compared with before administration and there was significant difference between the intravenous group and the oral group （P〈0.01）. The dosages of EPO in both groups after administration were lower than before administration,whereas the dosage in the intravenous group decreased significantly （P〈0.05）. In the intravenous group, the adverse reactions were significantly lower and the effect of EPO was significantly higher than in the oral group. [Conclusions] The intravenous iron can not only supply the iron to the patients with renal anemia,but also increase the effect of EPO and reduce the dosage of EPO. The adverse reactions of intravenous iron are low and it is safe and convenient.