补铁治疗对维持性血液透析患者贫血指标和促红细胞生成素类药物用量的影响

Effect of iron supplementation treatment on anemia and erythropoiesis-stimulating agents dosage of maintenance hemodialysis patients

目的观察补铁治疗对维持性血液透析患者贫血指标和促红细胞生成素类药物(ESAs)用量的影响。方法前瞻性入组2015年1-7月我科维持性血液透析患者169例,根据患者铁指标情况采用静脉补充铁剂或口服补充铁剂治疗,比较患者治疗前后的血红蛋白(Hb)、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)和ESAs治疗剂量。结果与治疗前相比,静脉补充铁剂治疗后患者的Hb、SF和TSAT水平均显著增加(P<0.05),ESAs使用剂量明显下降(P<0.01)。口服补充铁剂治疗后患者的Hb、SF、TSAT和ESAs使用剂量与治疗前相比,差异均不具有统计学意义(P>0.05)。结论针对铁储备明显低下的透析患者,通过静脉补充铁剂后可提高血透患者贫血指标,减少ESAs使用剂量;铁储备在理想范围的透析患者通过补充口服铁剂可稳定患者的Hb和铁指标,为患者的后续治疗提供了指导和帮助。

AIM To investigate the influence of iron supplementation treatment for patients with maintenance hemodialysis on anemia and erythropoiesis-stimulating agents （ESAs） dosage. METHODS A total of 169 patients, who received maintenance hemodialysis in our hospital, were prospectively enrolled from January to July 2015. The patients were treated with intravenous or oral iron agents according to intravenous iron or iron index. The levels of hemoglobin （Hb）, serum ferritin （SF）, transferrin saturation （T SAT） and the dosage of ESAs were compared before and after treat- ment. RESULTS Intravenous iron increased Hb, SF, and TSAT levels （P 〈 0.05）, and decreased ESAs dosage after treatment （P 〈 0.01）. There were no statistical differences of Hb, SF, TSAT and ESAs dosage in patients who received oral iron before and after treatment （ P 〉 0.05）. CONCLUSION For dialysis patients with low iron reserves obviously, intravenous iron supplementation can improve anemia index, and reduce the dosage of ESAs. Oral iron can maintain the Hb and iron indicators for dialysis patients with ideal iron reserves. Iron treatment provides guidance and help for dialysis patients with subsequent treatment.