高血清铁蛋白合并低转铁蛋白饱和度肾性贫血患者铁剂治疗的临床疗效分析

Clinical effects of iron on renal anemia patients with high serum ferritin and low transferrin saturation

目的探讨高血清铁蛋白(serum ferritin,SF)合并低转铁蛋白饱和度(transferrin saturation,TSAT)的维持性血液透析贫血患者是否需要静脉补充铁剂。方法根据入选标准和排除标准共入选患者21例。试验共分为2个阶段:无铁剂治疗阶段和静脉铁剂治疗阶段,每个阶段观察6周,每个阶段第1周和第6周的第2次透析前监测血红蛋白(hemoglobin,Hb)、SF、总铁结合力(total iron binding capacity,TIBC)、血清铁(ferrum,Fe)、C反应蛋白(C-reactive protein,CRP)变化。静脉铁剂治疗方法:每次透析后给予患者右旋糖酐铁100mg,共8次。比较每个试验阶段前后Hb、SF、TIBC、Fe和CRP的差别。结果①无铁剂治疗阶段与治疗前相比,SF有下降趋势,但差异无显著性(P>0.05);②静脉铁剂治疗后SF、Fe、TSAT和Hb均高于治疗前,差异有显著性(P<0.05)。结论大多数高SF合并低TSAT的维持性血液透析贫血患者仍存在铁缺乏,给予该类患者静脉铁剂治疗,有利于贫血的改善。

[ Objective ] To investigate whether intravenous iron was supplied to the maintained hemodialysis pa- tients with high serum ferritin （SF） and low transferrin saturation @SAT）. [Methods] 21 hemodialysis patients were selected according to the selecting and removing standards. The clinical trial included the two stages： no iron and in- travenous iron therapy stage. The time lasted six weeks in each stage. A series of biochemical tests were performed before second dialysis session of week 1 and week 2 such as hemoglobin （Hb）, SF, total iron binding capacity （TIBC）, ferrum （Fe）, C-reactive protein （CRP）. 0.8-g of intravenous iron administered in eight consecutive 100-rag doses beginning with the first dialysis session of week 1 was given to patients after hemodialysis. Hb,SF,TIBC,Fe and CRP were compared between before and after therapy in each stage. [ Results ] 1. No iron therapy stage： SF of dial- ysis patients after trial was lower than before trial （P 〉0.05）; 2. Intravenous iron therapy stage： SF, Fe, TSAT, Hb of dialysis patients after trial was lower than before trial （P 〈0.05）. [ Conclusions ] There is iron deficiency in the majority of maintained hemodialysis patients with high serum ferritin （SF） and low transferrin saturation （TSAT）. Administration of intravenous iron in these patients could overcome iron deficiency, benefit to improve renal anemia.