静脉注射与口服铁剂治疗肾性贫血的疗效比较

Curative Efficacy of Intravenous Administration vs. Oral Administration of Iron for Renal Anemia

目的：比较静脉注射铁剂与口服铁剂治疗慢性肾衰竭患者肾性贫血的临床效果。方法：对入选的60例肾性贫血患者以随机抽样法分为2组，每组各30例，在皮下注射基因重组人红细胞生成素（EPO）的基础上，分别采用静脉注射铁剂（静脉组）和口服铁剂（口服组）治疗。静脉组患者给予蔗糖铁静脉滴注，完成总量后，根据患者铁蛋白和血红蛋白（Hb）水平，定期给予100mg维持量。口服组患者口服琥珀酸亚铁200mg，1日3次。以铁剂治疗前后患者Hb和红细胞比容（Hct）的变化等衡量治疗效果。结果：治疗12周后，2组患者Hh、Hct、血清铁（SI），血清铁蛋白（SF）、转铁蛋白饱和度（TSAT）水平均较治疗前显著升高（P〈0．01）；患者Hb、Hct改变方面，2组比较，差异无统计学意义（P〉0．05）；静脉组患者SF、TSAT上升幅度显著高于口服组（P〈0．01）。结论：静脉组比口服组疗效更好，对于慢性肾衰竭内生肌酐清除率为10～30ml／min的患者，在皮下注射EPO的基础上，联合静脉注射铁剂治疗肾性贫血比口服铁剂更具效果，值得临床推荐。

OBJECTIVE ： To evaluate the curative efficacy of intravenous versus oral administration of iron for renal anemia in patients with chronic renal failure. METHODS： A total of 60 patients with renal anemia were randomized to two groups of 30 cases each treated with subcutaneous injection of recombinant human erythropoietin （ EPO ） plus either intravenous administration of iron （intravenous group ） or oral administration of iron （oral group ）. The intravenous group received add-on iron sucrose by iv gtt （in full dose） followed by maintenance dose （100 rag） on a regular basis based on patients＇ ferroprotein and hemoglobin （Hb） levels, while the oral group were treated with oral ferrous succinate （200 mg） t. i. d. The therapeutic efficacy was evaluated based on the changes in Hb and hematocrit （Hct） before and after treatment. RESULTS： After 12 weeks of treatment, Hb, Hct, serum iron （SI）, serum ferritin （SF）, transferrin saturation （TSAT） levels were significantly increased in both groups as compared with before treatment （P 〈 0. 01 ）; with regard to Hb and Hct changes, the differences between the two groups were not statistically significant （P 〉 0. 05） ; the intravenous group had significantly greater elevation of SF and TSAT than in the oral group （ P 〈 0. 01 ）. CONCLUSION ： The Intravenous group showed better curative efficacy than in the oral group. For patients with for chronic renal failure at endogenous creatinine clearance rate of 10-30 ml/min, in addition to subcutaneous administration of EPO, the add-on intravenous administration of iron resulted in better efficacy than the add-on oral administration of iron for renal anemia, hence the intravenous administration of iron is worthy of clinical recommendation.