静脉补铁与口服补铁治疗维持性血液透析患者肾性贫血的疗效观察

目的比较促红细胞生成素联合蔗糖铁注射液及加服维生素E或口服琥珀酸亚铁两种补铁方法治疗维持性血液透析（MHD）患者肾性贫血的临床疗效。方法选择MHD合并肾性贫血患者36例，随机分为A组（促红细胞生成素＋静脉补铁＋口服维生素E）和B组（促红细胞生成素＋口服补铁），每组18例。A组静脉用蔗糖铁（前4周2次／周，以后1次／周，均每次100mg），同时加服维生素E200mg，2次／d，总疗程12周。B组口服琥珀酸亚铁200mg，3次／d，总疗程12周。两组患者均同时使用促红细胞生成素，剂量6000—9000IU／周，皮下注射。检测两组患者治疗前后的红细胞相关指标、血清铁指标、氧化应激指标及血脂。结果治疗12周后，两组患者Hb、Hct都有明显升高，但B组相对较慢，两组比较差异有统计学意义，而Ret两组治疗前后差异无统计学意义；SF两组患者均较治疗前有明显升高，A组更加显著，两组差异有统计学意义（P〈0．05）；hs—CRP两组治疗前后差异均无统计学意义。两组患者治疗12周后，TG、LDL及Lp（a）水平与治疗前比较均升高（P〈0．05），且A组比同期B组也略高，但两者比较差异无统计学意义；CH、HDL、ApoAl和ApoB的含量治疗后与治疗前相比差异无统计学意义。结论静脉使用蔗糖铁可有效地纠正MHD患者铁缺乏，能有效改善贫血，且安全性较好，而口服维生素E可以改善MHD患者因静脉补铁所诱导的氧化应激及脂代谢紊乱。

Objective To compare the therapeutic efficiency between iron sucrose and ferrous succinate in maintenance hemodialysis（MHD） patients with renal anemia. Methods Thirty -six MHD patients were selected and randomly divided into group A（ erythropoietin ＋ intravenous iron ＋ vitamin E ） （ n = 18 ） and group B （ erythropoietin ＋ oral ferrous succinate ） （ n = 18 ）. Group A receiving intravenous iron sucrose 200 mg once a week for 4 weeks and then 100 mg onee a week for a further 8 weeks and add oral vitamin E 200 mg,two times one day for 12 weeks. Group B received oral ferrous succinate 200 mg three times a day for 12 weeks. Erythropoielin（rHuEPO） was used at a dose of 6000 -90001U per week by hypodermic in each group for 12 weeks. The levels of hemoglobin（Hb） , hematocrit （Hct） , serum ferritin （SF） , high - sensitivity C - reactive protein （ hs - CRP） and lipid metabolism parameters were examined before and ＇,flier treatment. Results After 12 weeks of treatment, two groups of patients with Hh, Hct were significantly increased, but the group B increased more slowly. The levels of group A were significantly higher than those of group B after treatment （ P 〈 0.05 ）. But there was no significant difference of reticulocytes （Ret） of two groups after treatment. SF was significantly higher after treatment and group A was more higher than group B （ P 〈 0.05 ）. There was no significant differences in hs -CRP between two groups before and after treatment. TG, LDL and Lp（a） levels were higher than those of 12 weeks before treatment（ P 〈0. 05 ） , but it showed no statistically significant difference in two groups after treatment（ P 〉0.05）. There was no significant differences of CH, HDL, ApoA1 and ApoB levels in the before and after treatment（P 〉 0.05）. Conclusion Intravenous iron sucrose can effectively correct the MHD patients with iron defieiency, improving anemia and with good safety. While oral administration of vitamin E can attenuate oxidative stress and lipid metabolism disorders induced bv intravenous iron.