静脉注射铁剂治疗血液透析患者肾性贫血的疗效观察

Efficacy Observation of Intravenous Iron Sucrose Therapy in Anemic Hemodialysis Patients

目的比较静脉注射蔗糖铁与口服硫酸亚铁治疗血液透析患者肾性贫血的疗效与安全性。方法选择40例血液透析(HD)患者,分为静脉补铁组和口服铁组,每组20例。静脉补铁组:每次血液透析时静脉注射100mg蔗糖铁,直到完成总补铁量。口服组:硫酸亚铁300mg每日3次,共12周,均同时使用基因重组人红细胞生成素(EPO)50U/kg每周3次,皮下注射。比较两组肾性贫血的疗效与安全性。结果结束治疗后Hb、Hct、Ret均较治疗前有显著升高,静脉Hb、Hct、Ret升高比口服组升高更显著(经非配对t检验和协方差分析,P<0.01),静脉组Hb上升速度明显快于口服组,从而节省EPO剂量,静脉组治疗后,血清铁、铁蛋白、转铁蛋白的饱和度(TSAT)均明显升高(P<0.05)。肝、肾功能治疗前后无显著性差异。静脉组0例出现不良反应,口服组4例出现不良反应,主要表现为消化道反应,包括反酸、恶心、呕吐、胃部烧灼感、便秘,两组之间有显著性差异(P<0.05)。结论静脉用蔗糖铁治疗肾性贫血比口服铁更安全、更有效。

Objective To compare the efficacy and safety of intravenous iron with oral ferrous in EPO-treated hemedialysis patients. Methods Forty hemodialysis patients were selected at random.there twenty in intravenous irons sucrose group and twenty in oral ferrous sul- fate group. Patients of iv group received 100mg iron sucrose（ senthe neng）with 100mL saline intravenously during each hemodialysis session fill at the reach of total suplement iron, while patients in oral group took ferrous sulfate 900mg per day （ 300mg tid ） orally for twenty weeks. Two groups patients all received 50U/kg EPO ih per day. The efficacy and safety were compared. Results At the end of the trial the Hb. hemotoornt（Hct） and reticular erythrocyte（Ret） was significantly increased in both group,while the increment of Hb,Hct and Red in Iv group was significandy higher than that in oral group （by independent-sample test and analysis of covariate P〈 0.01 ）. The increment rate of Hb in Iv group was makely faster than that in oral group which decreased the dosage of EPO.Serum iron,ferrition and transferrin saturation（T SAT）increased significantly in Iv group（P〈 0.05）. There was no significant change in hepatio and renal function after the trial. There were 4 Patients in oral group had adverse effects and 0 in Iv group. Main adverse effects included nausea, voinit,constipation and acid-regurgitation. There are significant difference in two groups （P 〈 0.05 ）. Conclusion The intravenous iron sucrose is more effective and safer than oral ferrous in treating anemic hemodialysis patients.