重度肾性贫血输血前后铁储备评估的意义

Significance of assess the iron reserves of Severe renal anemia Patients before and after blood transfusion

目的:探讨重度肾性贫血输血前后血红蛋白及铁储备评估的意义,以指导临床治疗。方法:从本院肾病科简单随机抽取慢性肾衰5期规律透析的重度肾性贫血患者120例,根据输血前铁储备情况将其分为铁储备不足与铁储备正常组与铁储备超负荷组,并对三组再均分成输入1单位悬浮红细胞组(即1U组)与输入2单位悬浮红细胞组(即2U组)。对比输血不同输血单位数量前后血红蛋白、血清铁、铁蛋白及总铁结合力的变化及组间比较变化量。结果:三组1U组输血1U后,血红蛋白、血清铁、铁蛋白、总铁结合力、转铁蛋白饱和度均较输血前升高,差异均具有统计学意义(P<0.05);铁储备不足1U组输血前后血红蛋白、血清铁、铁蛋白、总铁结合力、转铁蛋白饱和度变化量与铁储备正常1U组比较,差异无统计学意义(P>0.05),铁储备超负荷1U组输血前后血红蛋白、血清铁、铁蛋白、总铁结合力、转铁蛋白饱和度变化量显著大于铁储备不足1U组与铁储备正常1U组,差异均具有统计学意义(P<0.05);三组2U组输血2U后,血红蛋白、血清铁、铁蛋白、总铁结合力、转铁蛋白饱和度均较输血前升高,差异均具有统计学意义(P<0.05);铁储备超负荷2U组输血前后血红蛋白、血清铁、铁蛋白、总铁结合力、转铁蛋白饱和度变化量大于铁储备不足2U组与铁储备正常2U组,且铁储备正常2U组高于铁储备不足2U组,差异均具有统计学意义(P<0.05)。结论:重度肾性贫血输血对患者的铁储备有影响,在后续治疗中继续输血治疗或应用铁剂的治疗剂量应根据输血单位数量进行调整,对纠正贫血铁剂的用药剂量及防治铁超负荷出现意义重大。

Objective： To study the significance of evaluating hemoglobin and iron reserves in the severe renal anemia patient before and after blood transfusion, to guide clinical treatment. Methods： Simple randomly selected 120 patients in phase 5 of chronic renal failure from the department of nephrology, who are regular dialysis with severe renal anemia, according to the situation of iron reserves before blood transfusion , patients will be divided into its reserves of iron deficiency and iron overload group and normal group, and the three groups were divided into 1U and 2U group. Comparing the change of different unit quantity of hemoglobin, serum iron, iron, protein and total iron binding force before and after blood transfusion and variation is compared between groups. Results; Three groups of patients with 1U blood transfusion , Hemoglobin, serum iron and ferritin, total iron binding force, transferrin saturation are higher before a blood transfusion, The differences were statistically significant （P〈0.05）; before and after blood transfusion hemoglobin, serum iron and ferritin, total iron binding force, transferrin satu- ration change in 1U group normal iron reserves compared with Insufficient iron reserves 1U group has no statistically significant difference （P〈0.05）, iron overload 1U group before and after blood transfusion hemoglobin, serum iron and ferritin, total i- ron binding force, transferrin saturation change significantly greater than Insuffieient iron reserves 1U group and 1U with nor- mal iron reserves group, the differences were statistically significant （P〈0.05） ; Three groups of patients blood transfusion af- ter 2U, hemoglobin, serum iron and ferritin, total iron binding force, transferrin saturation were higher before a blood transfu- sion, differences were statistically significant （P〈0.05）3 iron overload 2U group before and after blood transfusion hemoglo- bin, serum iron and ferritin, total iron binding force, transferrin saturation change significantly greater than Insufficient iron reserves 2U group and normal iron reserves 2U, 2U iron overload group is higher than normal iron and Insufficient iron re- serves 2U group, the differences were statistically significant （all P〈0.05）. Conclusion： Blood transfusion have an influence on iron reserves in patients with severe renal anemia, in the subsequent treatment in blood transfusion treatment or an iron agent treatment, dosage should be adjusted, according to blood transfusion unit quantity, for correction of anemia iron agent dosage and the prevention and treatment of iron overload is of great significance.