静脉注射右旋糖酐铁优于口服琥珀酸亚铁治疗血液透析铁缺乏贫血

Intravenous iron dextran more effective than oral ferrous succinate for hemodialysis anemia in patients with iron deficiency

目的 :比较静脉铁剂与口服铁剂在治疗透析相关性贫血中的疗效。方法 :2 3例病人随机分入静脉铁剂组 (静脉组 )和口服铁剂组 (口服组 ) ,前者给予右旋糖酐铁 10 0mg ,在病人每次透析中经透析器的静脉端输入 ,直至完成总预计补铁量 (15 36±s2 5 4 )mg ,观察时间约 6～ 8wk ;后者给予琥珀酸亚铁 2 0 0mg ,po ,每日 3次 ,连续服用 8wk。 2组病人均同时使用促红细胞生成素治疗。结果 :静脉铁剂组治疗 8wk后 ,血红蛋白增长 (15± 12 )g·L- 1,红细胞比容增长 (4± 3) % ,血清铁蛋白增长 (330±15 8) μg·L- 1,而口服铁剂组三者分别为 (3± 11)g·L- 1,(0 .7± 2 .3) %和 (10 2± 2 2 4 ) μg·L- 1,差异有显著意义 (P <0 .0 5 ) ;静脉铁剂组的有效率为 5 5 % ,而口服铁剂组为 2 5 % ,两者差异有非常显著意义 (P<0 .0 1)。不良反应发生率静脉铁剂组是 9% ,口服铁剂组为 33%。结论 :静脉铁剂在治疗血液透析贫血病人铁缺乏时安全有效 。

AIM: To compare the effect of intravenous iron with that of oral iron for the treatment of dialysis-associated anemia. METHODS: Twenty-three patients were randomly divided into intravenous iron group (eleven patients) and oral iron group (twelve patients). In intravenous iron group, iron dextran 100 mg was imput through the venous end of dialyser at every dialysis up to complete the total dosage estimated. In oral iron group, ferrous succinate 200 mg, tid, for 8 wk. All patients received recombinant human erythropoietin. RESULTS: After 8 wk treatment, the mean hemoglobin, hematocrit, and serum ferritin increased significantly greater in intrnvenous iron group than that in oral iron group ((15±12) g·L -1 vs (3±11) g·L -1, (4±3) % vs (0.7±2.3) %, and (330±158) μg·L -1 vs (102±224) μg·L -1, respectively, P< 0.05). The effective rate at 8 wk was significantly highter in intravenous iron group than that in oral iron group (55% vs 25%, P< 0.01). There were no serious adverse reactions in all study patients. The general adverse reactions were wore less in intravenous iron group(9 %) than that in oral iron group (33%). CONCLUSION: Intravenous iron is both effective and safe. Intravenous iron is more effective than oral iron for hemodialysis anemia in patients with iron deficiency.