两种透析方式联合蔗糖铁改善肾性贫血临床研究

Clinical study on the improvement of renal anemia by two dialysis methods combined with iron sucrose

目的探讨两种不同透析方式联合蔗糖铁对慢性肾病患者肾性贫血的改善作用。方法选择2010年1月至2015年12月在解放军163医院维持透析的406例肾性贫血患者为研究对象,根据不同透析方式将患者分为观察组(腹膜透析,94例)与对照组(血液透析,312例)。两组患者透析期间均行蔗糖铁静脉给药,比较两组的临床疗效、不良反应,治疗前后贫血、铁代谢及微炎症等指标。结果观察组治疗总有效率87.2%,显著高于对照组的69.9%(P<0.05)。观察组治疗两个疗程后,血红蛋白(Hb)、红细胞压积(PCV)、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)水平分别为(111.0±8.5)g/L、(32.1%±5.6%)、(497.5±100.4)μg/L、(42.2%±7.0%),均显著高于对照组的(95.5±9.0)g/L、(27.8%±4.5%)、(313.2±73.9)μg/L、(32.6%±4.5%),差异均有统计学意义(P<0.05)。两组治疗两个疗程后,白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)水平较治疗前明显上升,且观察组hs-CRP水平明显高于对照组,差异有统计学意义(P<0.05)。两组患者均无明显药物不良反应发生。结论腹膜透析、血液透析联合蔗糖铁静脉治疗均能明显改善肾性贫血状态,且腹膜透析比血液透析效果更显著。另外,血液透析比腹膜透析微炎症状态轻,需重视并采取有效措施改善患者微炎症状态。

Objective To investigate the improvement effect of two different dialysis methods combined with iron sucrose on renal anemia in patients with chronic kidney disease. Methods A retrospective study was performed on 406 patients with renal anemia who underwent maintenance dialysis in No. 163 Hospital of PLA between January 2010 and December 2015. The patients were divided into the observation group（ peritoneal dialysis,94 cases） and the control group（ hemodialysis,312 cases） according to different dialysis modalities. During dialysis,all patients were given intravenous administration of iron sucrose. The clinical curative effects,adverse reactions,anemia before and after treatment,iron metabolism and micro-inflammation indexes were compared between the two groups.Results The total effective rate in the observation group（87. 2%） was significantly higher than that in the control group（69. 9%）（P〈0. 05）. After 2 courses of treatment,Hb,PCV,SF and TSAT levels in the observation group[（111. 0 ± 8. 5） g/L,（32. 1% ±5. 6%）,（497. 5 ± 100. 4） μg / L,（42. 2% ± 7. 0%）] were significantly higher than those in the control group[（95. 5 ± 9. 0） g / L,（27. 8% ± 4. 5%）,（313. 2 ± 73. 9） μg/ L,（32. 6% ± 4. 5%）]（P〈0. 05）. After 2 courses of treatment,IL-6 and hs-CRP levels were significantly higher than those before treatment. Furthermore,the hs-CRP level in the observation group was significantly higher than that in the control group（ P〈0. 05）. There was no adverse drug reaction. Conclusion Peritoneal dialysis,hemodialysis combined with intravenous administration of iron sucrose can significantly improve the state of renal anemia,and the effect of peritoneal dialysis is more significant than that of hemodialysis. Meanwhile,the micro-inflammatory state of hemodialysis is milder than that of peritoneal dialysis,which needs attention and effective measures should be taken to relieve the micro-inflammatory state.