静脉铁不同给药方案对维持性血液透析患者贫血及氧化应激反应的影响

The effect of different schedule for intravenous iron administration on anemia and oxidative stress response in maintenance hemodialysis patients

目的观察静脉铁(蔗糖铁注射液)的不同给药方案(给药总剂量相同但给药次数和单次给药剂量不同)对维持性血液透析(MHD)患者贫血的疗效及其体内氧化应激反应的影响,寻求既方便、安全又经济、高效的给药方案。方法选择2006年～2007年于中国医科大学附属第四医院MDH患者70例,采用前瞻性、随机对照研究,随机分为5组,观察各组用药前后血红蛋白(Hb)浓度、红细胞压积(Hct)、血清铁(SI)、血清铁蛋白(SF)等疗效指标以及C反应蛋白(CRP)、血清中丙二醛(MDA)、过氧化物歧化酶(SOD)等微炎症和氧化指标,并监测不良反应。结果用药8周后,静脉补铁组Hb、Hct、SF水平与用药前相比均明显升高(P<0.01);而静脉补铁方案不同(100mg×10次,200mg×5次,500mg×2次)各组间比较无显著性差异(P>0.05)。MHD患者治疗前血清SOD低于健康组(P<0.01),CRP和血清MDA高于健康组(P<0.01,P<0.01)。治疗8周后,静脉补铁组血清SOD均较治疗前显著下降(P<0.05),CRP和血清MDA均较治疗前显著升高(P<0.05),但静脉补铁方案不同各组间比较差异无统计学意义(P>0.05)。结论蔗糖铁注射液三种不同静脉给药方法均有效改善MHD患者的贫血及缺铁,且疗效相当,以500mg×2次给药方案更为方便。长期静脉补铁可能对体内氧化应激产生一定影响,需进一步研究。

Objective To observe the effect of different schedules for intravenous iron administration on uremic anemia, microinflammation and oxidative stress response in maintenance hemodialysis （MHD） patients, in order to find out a convenient, safe and efficient iron administration for these patients. Methods We prospectively studied 70 MHD patients treated in the Fourth China Medical University Hospital during the period of 2006 to 2007. They were randomly assigned into 5 groups to observe their hematological changes of hemoglobin （Fib）, hematocrit （Hct）, serum iron （SI） and serum ferritin （SF）, as well as the microinflammation and oxidative stress parameters of serum C reactive protein （CRP）, malondialdehyde （MDA） and superoxide dismutase （SOD） before and after the treatment. The side effects of iron therapy were also recorded. Results After the iron treatment for 8 weeks, Hb, Hct and SF increased significantly in the intravenous iron administration groups （P〈0.01）, but had no differences among the intravenous iron administration groups of 100mg for one dose, 200mg for 5 times, and 500mg for 2 times （P 〉 0.05）. MHD patients had lower serum SOD activity and higher serum CRP and MDA concentrations, as compared with those of healthy controls （P〈 0.01）. Serum SOD activity decreased and serum CRP and MDA concentrations increased in the intravenous iron administration groups after the treatment for 8 weeks （P〈0.05）. However, these parameters showed no differences in the 3 intravenous administration groups of various doses. Conclusion The 3 methods of intravenous sucrose iron administration are equally effective to improve anemia, iron deficiency, microinflammation and oxidative status without considerable side effects in MHD patients. The method of intravenous 500mg sucrose iron for 2 times is relatively convenient.