静脉应用蔗糖铁纠正功能性缺铁对血液透析患者贫血的作用

The effect of correction of functional iron deficiency with intravenous iron sucrose on the anemia in hemodialysis patients

目的 通过比较静脉铁剂蔗糖铁注射液和口服铁剂琥珀酸亚铁分别联合应用基因重组人红细胞生成素 (EPO) ,治疗伴有功能性缺铁的维持血液透析患者贫血的疗效 ,探讨对功能性缺铁的补铁途径和方法。方法 采用前瞻性、随机、对照的研究。 2 5例维持血液透析、存在功能性缺铁和贫血的患者分为静脉组和口服组 ;①静脉组 13例 ,10 0mg蔗糖铁注射液稀释于 10 0ml生理盐水 ,透析中静脉滴注 ,每周一次 ,共 10次 ,总补铁量 10 0 0mg ;②口服组 12例 ,琥珀酸亚铁 2 0 0mg每日 3次 ,共 10周。两组患者均联合EPO治疗 ,剂量为 10 0～ 180U/kg/week ,均皮下注射。每 2周检测 1次患者的血红蛋白 (Hb)、红细胞压积 (Hct)和网织红细胞 (Ret) ;每 4周查 1次网织红细胞血红蛋白含量 (reticulocytehemoglobincontent,CHr)、低色素红细胞百分比 (percentageofhypochromicredbloodcells,%HRC)、血清铁蛋白 (serumferritin ,SF)和转铁蛋白饱和度(transferritinsaturation ,TS) ;治疗前和治疗后分别取血查叶酸、VitaminB12 、CRP、ALT、AST、Tbil、Alb、BUN和Cr等。结果 治疗前静脉组与口服组之间在男、女性别比例、年龄、体重和接受治疗前维持透析时间及Hb、Hct、Ret、CHr、%HRC、SF和TS等方面均无显著性差异别。静脉组Hb、Hct、

Objective Iron deficiency, especially functional iron deficiency, is one of the most common causes of a suboptimal response to recombinant human erythropoietin (EPO) therapy in anemic hemodialysis patients, therefore iron supplementation is important for the patients. In view of current uncertainty regarding the optimum route for iron supplementation, a prospective randomized controlled study was designed to investigate this issue. Methods Tweenty-five hemodialysis patients who had a hemoglobin concentration of 60～90g/L, a serum ferritin concentration of (100～500)g/L and transferritin saturation less than 20%, were randomized into two groups with different route of iron supplementation. ① Intravenous iron group (IV group), 13 patients, administered intravenous iron sucrose 100mg per week. ② Oral iron group (Oral group), 12 patients, oral ferrous succinate 200mg tid. All patients were treated with 100～180U/kg/week of EPO subcutaneously. The hemoglobin (Hb) concentration, hematocrit (Hct) and reticulocyte (Ret) count were monitored every two weeks, and the reticulocyte hemoglobin content (CHr), percentage of hypochromic red cells (%HRC), serum ferritin (SF) and transferritin saturation (TS) every four weeks. Results The two groups were equivalent with regard to age, sex, duration of hemodialysis and body weight. Before treatment there were no differences between the groups in Hb, Hct, Ret, CHr, %HRC, SF and TS. At the end of the trial, the Hb and Hct in both groups significantly increased respectively. The response of the Hb and Hct in IV group was markedly greater than that in oral group respectively [Hb (104.4±8.1) vs (96.3 ± 5.5) g/L, P < 0.01; and Hct 31.4% ± 2.5% vs 29.1% ± 1.6%, P<0.05, respectively]. The CHr, SF and TS in IV group increased significantly [CHr (27.1±1.2)pg vs (29.9 ± 1.5)pg,P<0.001; SF(211±71)μg/L vs (283±62)μg/L,P<0.01;and TS 13.3%±3.4% vs 20.0%±2.9%, P<0.01, respectively], The %HRC decreased significantly (from 5.7%±3.1% to 2.6%±1.2%, P<0.001). The CHr, %HRC, SF and TS in Oral group remained constant. There was no significant difference in average dosages of EPO between the two groups [IV group (141±11) vs Oral group (136±16)U/kg/w, P>0.05]. The serum levels of folate, VitaminB 12 , CRP, ALT, AST, Tbil, Alb, Cr and BUN in both groups did not change significantly. There were no severe adverse events in both groups. Conclusions The results of the study suggest that, even in iron-replete patients suffering from functional iron deficiency, those supplemented with intravenous iron have an enhanced hemoglobin response to EPO with better maintenance of iron stores, compared with those patients receiving oral iron.