静脉补铁治疗血液透析患者肾性贫血的疗效观察

Effectiveness of intravenous iron treatment in anemic hemodialysis patients

目的评价静脉用铁剂蔗糖铁(森铁能)、口服铁剂琥珀酸亚铁片(速力菲)分别与基因重组红细胞生成素(rHuEPO)联合应用,治疗伴有缺铁的维持性血液透析(MHD)患者肾性贫血的有效性和安全性。方法72例MHD患者,随机分为静脉组和口服组,每组36例,分别采用静脉注射蔗糖铁及口服琥珀酸亚铁片进行补铁治疗,治疗时间为5周,观察时间共8周。治疗前,两组患者男女性别比例、年龄、维持血液透析时间、血红蛋白(Hb)、血细胞比容、血清铁蛋白(SF)和转铁蛋白饱和度(TSAT)等均无显著性差异。全部病例都合并使用同等剂量rHuEPO治疗。观察并比较两组患者治疗贫血的效果、铁代谢指标变化及不良反应发生情况。结果治疗8周时,静脉组Hb和口服组Hb均较治疗前明显提高(P<0.01,P<0.05),而静脉组Hb上升幅度明显高于口服组(P<0.01);两组SF和TSAT均较治疗前明显提高(P<0.01,P<0.05),而静脉组上升幅度明显高于口服组(P<0.01);总有效率静脉组明显高于口服组(P<0.01);静脉组不良反应发生率(0/36,0%)明显低于口服组(15/36,41.7%)。结论静脉注射蔗糖铁可有效纠正维持血液透析患者的铁缺乏、提高铁利用率及rHuEPO的治疗效果,不良反应发生率低,安全性好。

Objective To investigate and compare the efficiency and safety of intravenous iron sucrose with oral ferrous succinate for the treatment of iron deficiency in recombinant human erythropoietin （rHuEPO） -treated anemic hemodialysis patients. Methods 72 chronic hemodialysis patients were divided into two groups：treatment group（i- ron sucrose group, n = 36） and control group（ferrous succinate group, n = 36）. The patients were treated with iron sucrose, 100 mg intravenous, during 10 consecutive hemodialysis sessions,twice a week for five weeks. The duration of follow-up was eight weeks. There were no significant differences in the basic data （ gender, age, duration of hemodialysis, Hb, Hct, serum ferritin and transferring saturation, etc）between two groups at pre-treatment. Each patient of both groups received rHuEPO treatment, 120 - 150 U/（ kg · week）. The efficacy was assessed by determining the subsequent change in Hb, ferritin and transferring saturation values. Results After treatment, the levels of Hb, Hct, SF and TSAT were all significantly increased in HD, which were also significantly higher than those in oral ferrous succinate. The rate of side-effect in intravenous iron sucrose （0%）was significantly lower than that in oral ferrous succinate（41.7% ,P 〈 0.01 ）. Conclusion Intravenous iron sucrose can effectively increase serum iron parameter and hemoglobin levels in anemic hemodialysis patients, with relatively high degree of safety.