总剂量注射静脉铁剂对老年腹透患者贫血及微炎症的影响

Influence of intravenous infusion of total dose iron on anemia and microinflammation in elderly patients on peritoneal dialysis

目的探讨总剂量注射静脉铁剂对老年腹膜透析患者的贫血及微炎症状态的影响。方法选择第二军医人学附属长海医院。肾内科46例长期不卧床腹膜透析（CAPD）患者进行总剂量注射静脉铁剂临床观察。根据年龄分为A组（≥60岁）和B组（〈60岁），观察用药前后血红蛋白浓度（Hb）、红细胞压积（Hct）、血清铁（SI）、血清铁蛋白（SF）、转铁蛋白饱和度（TSAT）等指标以及血清C-反应蛋白（CRP）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）等炎症指标并监测不良反应。结果（1）用药后的3个月、6个月，两组的Hb、Hct、SF、TSAT较用药前上升，有统计学意义（P〈0．05）。用药6个月后，两组的Hb、Hct、SF、TSAT增加百分数差异无统计学意义（P〉0．05）。（2）用药6个月后，两组患者的血清CRP、IL-6、TNF-α较治疗前有所下降，但无统计学意义（P〉0．05）。（3）A组有1例发生轻度胃肠道反应，B组有1例发生轻微心悸。A组总不良反应发生率（1／26，3．85％）和B组（1／20，5．00％）无统计学意义（P〉0．05）。结论总剂量注射静脉铁剂可有效纠正老年腹膜透析患者的铁缺乏，提高铁利用率，不良反应发生率低，安全性良好，且未加重其微炎症状态。

Objective To investigate the influence of intravenous infusion of total dose iron on anemia and microin- flammation in elderly patients on peritoneal dialysis. Methods Forty-six patients on peritoneal dialysis were divided into two agegroups： group A （≥60years） and groupB （〈60years）. Hematocrit （HCT）, hemoglobin （HB）, serum iron, serum ferrintin （SF）, transferrin saturation （TSAT） and biomarkers of inflammation including serum C-reactive protein, interleukin-6 and tumor necrosis factor-α were measured before and after iron administration. Results 1） HB, HCT, SF and TSAT levels increased significantly 3 and 6 months after treatment （P〈0.05）; 2） C-reactive protein, interleukin-6 and tumor necrosis factor-or were similar in both groups 6 months after treatment （P 〉 0.05）; and 3） the adverse reactions were similar between group A and B （1/26, 3.85% vs 1/20, 5.00%） （P〉0.05）. Conclusion Intravenous infusion of total dose iron can effectively increase serum iron parameters and HB level in elderly patients on peritoneal dialysis, and is relatively safe and would not aggravate the status of microinflammation.