蔗糖铁联合左卡尼汀注射液对维持性血液透析尿毒症患者肾性贫血血红蛋白达标率及肾功能的影响

Effect of iron sucrose combined with levocannabinoids on Hb attainment and renal function in patients with uremia on maintenance hemodialysis uremia

目的研究蔗糖铁联合左卡尼汀注射液对维持性血液透析(MHD)尿毒症患者肾性贫血血红蛋白(Hb)达标率及肾功能的影响。方法选择我院收治的104例维持性血液透析尿毒症肾性贫血患者为研究对象,采用随机数字表法分为对照组、联合组,各52例。2组均给予纠正贫血常规治疗,对照组在常规治疗基础上采用左卡尼汀注射液治疗,联合组在对照组基础上采用蔗糖铁治疗。比较2组临床疗效及Hb达标率、治疗前及治疗8周、16周后贫血相关指标[Hb、红细胞压积(HCT)、铁蛋白(SF)、转铁蛋白饱和度(TSAT)]、肾功能指标[尿素氮(BUN)、血肌酐(Scr)、24 h尿蛋白排泄率(24 h UPE)、β2-微球蛋白(β2-MG)]、血清铁调素、核转录因子-κB(NF-κB)水平、不良反应发生率。结果联合组临床总有效率及Hb达标率分别为92.3%、69.2%,高于对照组76.9%、48.1%(P<0.05);与治疗前比较,2组治疗8周、16周后Hb、HCT、SF、TSAT水平均升高,且联合组高于对照组(P<0.05);与治疗前比较,2组治疗8周、16周后BUN、Scr、24 h UPE、β2-MG水平均降低,且联合组低于对照组(P<0.05);与治疗前比较,2组治疗8周、16周后血清铁调素、NF-κB水平均降低,且联合组低于对照组(P<0.05);联合组不良反应总发生率(9.6%)高于对照组(5.8%)(P>0.05)。结论采用蔗糖铁与左卡尼汀注射液联合治疗可有效促进MHD尿毒症肾性贫血患者肾功能及贫血状态改善,减轻炎症反应,提高临床疗效,且有一定安全性。

Objective To study the effect of iron sucrose combined with levocarnitine on the attainment rate of renal anemia hemoglobin(Hb)and renal function in patients with uremia on maintenance hemodialysis(MHD).Methods One hundred and four patients with uremic nephrogenic anemia on maintenance hemodialysis admitted to our hospital from April 2020 to August 2022 were studied,and were divided into control group(n=52)and combined group(n=52)by random number table method.Both groups were given conventional treatment for correction of anemia,and the control group was treated with levocarnitine on the basis of conventional treatment,and the combined group was treated with iron sucrose on the basis of control group.The clinical efficacy and Hb compliance rate,anemia-related indexes[Hb,hematocrit(HCT),ferritin(SF),transferrin saturation(TSAT)],renal function indexes[urea nitrogen(BUN),blood creatinine(Scr),24 h urinary protein excretion rate(24 h UPE),β2-microglobulin(β2-MG)],the incidence of adverse reactions,serum ferritin(Hepcidin),and nuclear transcription factor-κB(NF-κB)levels before and after 8 and 16 weeks of treatment were compared between the two groups.Results The total clinical efficiency and Hb attainment rate of the combined group were 92.3%and 69.2%,respectively,which were higher than those of the control group 76.9%and 48.1%(P<0.05).Compared with the pre-treatment period,the levels of Hb,HCT,SF,and TSAT were higher in the 2 groups after 8 and 16 weeks of treatment,and the combined group was higher than those in the control group(P<0.05).Compared with pre-treatment,BUN,Scr,24 h UPE,andβ2-MG levels were lower in both groups after 8 and 16 weeks of treatment,and the combined group was lower than the control group(P<0.05).Compared with pre-treatment,serum Hepcidin and NF-κB levels were lower in both groups after 8 and 16 weeks of treatment,and the combined group was lower than the control group(P<0.05).The overall incidence of adverse reactions in the combined group(9.6%)was higher than that in the control group(5.8%)(P>0.05).Conclusion The combination of iron sucrose and levocannabinoids can effectively promote the improvement of renal function and anemia status,reduce inflammatory response,and improve clinical efficacy in patients with uremic nephrogenic anemia of MHD with a certain degree of safety.