生血宁在慢性肾脏病非透析患者肾性贫血治疗中的疗效观察

Curative effectiveness of Shengxuening in the treatment of renal anemia of CKD non-dialysis patients

目的观察生血宁联合促红细胞生成素治疗慢性肾脏病（chronic kidney disease，CKD）非透析患者肾性贫血的疗效并和传统口服铁剂富马酸亚铁比较，以探寻治疗肾性贫血的优选方案。方法选择2012年3月至2013年9月在长航总医院肾内科住院的58例CKD非透析患者，在基础治疗[（降压、降糖、降尿酸、调脂、改善肾脏循环、维持水、电解质平衡及促红细胞生成素（erythropietin，EPO）的使用等）]相同的情况下随机分为口服生血宁与富马酸亚铁组，总疗程12周，观察血红蛋白、红细胞比容、血清铁蛋白、转铁蛋白饱和度及肾功能、血清白蛋白、超敏C反应蛋白及EPO使用剂量的变化，并对不良反应进行监测。结果治疗后2组患者的血红蛋白、红细胞比容、血清铁、总铁结合力、转铁蛋白饱和度及铁蛋白均有显著提高，EPO用量减少（P〈0．05）。但生血宁组转铁蛋白饱和度的升高和EPO用量的减少较富马酸亚铁组显著（P〈0．05），治疗前后超敏C反应蛋白无显著性变化（P〉0．05），且无明显的不良反应发生。富马酸亚铁组有8例出现上腹部不适、恶心、呕吐等，不良反应发生率为33．3％，治疗后超敏C反应蛋白显著升高（P〈0．05）。结论生血宁可显著纠正CKD非透析患者的缺铁，改善铁代谢状态，辅助治疗肾性贫血，疗效优于富马酸亚铁，且不影响患者微炎症状态，无明显不良反应。

Objective To observe the curative effectiveness of Shengxuening？ combined with erythropoietin vs. ferrous fumarate in the treatment of renal anemia of CKD non-dialysis patients to find the selective preference of treating renal anemia Methods Fifty-eight patients with renal anemia were randomly divided into Shengxuening group and ferrous fumarate group （n = 29 each）. The course of the treatment lasted for 12 weeks. Both groups received same basic treatment （anti-hypertension, glycemia regulation, blood-lipid regulation, uric acid dropping, improvement of kidney circulation, maintainence of water and electrolyte balance, and use of EPO, etc）. The changes of hemoglobin （Hb）, hematocrit （Hct）, serum ferritin （SF） and transferrin saturation （TAST）, renal function, Alb, hs-CRP, erythropoietin dose, and the adverse reactions before and after treatment were observed. Results Hb, Hct, TSAT and SF in both groups were significantly increased and the dosage of erythropoietin was reduced,after treatment （P〈0. 05）. As compared with ferrous fumarate group, TSAT was increased significantly and the dosage of erythropoietin was reduced in Shengxuening group （P〈0.05）. No obvious adverse reactions occurred in Shengxuening group. In ferrous fumarate group, the adverse reactions occurred in 8 cases, including addominal discomfort, nausea, vomiting, etc. The incidence of adverse reactions was 33. 3 %. The hsCRP level was significantly increased in ferrous fumarate group （P〈0. 05）. Conclusions Shengxuening can remarkably improve the iron metabolism and assist the treatment of renal anemia of CKD non-dialysis patients without obvious adverse reactions, and does not affect the micro-inflammatory state. The curative effectiveness of Shengxuening is more satisfactfory than that of ferrous fumarate.