肾性贫血时静脉与口服铁剂的疗效比较

唐琦; 汪关煜; 钱莹; 朱萍; 沈平雁

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中国血液净化 ›› 2004, Vol. 3 ›› Issue (8) : 431-434.

论著

肾性贫血时静脉与口服铁剂的疗效比较

唐琦汪关煜钱莹朱萍沈平雁

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摘要

慢性肾衰竭 (CRF)肾性贫血患者，缺铁十分常见，它不仅加重贫血而且影响促红细胞生成素（EPO）的疗效，以往常用口服铁剂，现又推荐静脉补铁目的以同一组24例血液透析患者，先用口服铁剂（琥珀酸亚铁，即速力菲），后用静脉铁剂（右旋糖酐氢氧化铁，即科莫非），以观察二种方法对纠正缺铁和改善贫血的效果及副作用。方法口服琥珀酸亚铁，每次200mg 每日3次，连续2月，停药2月；以后同组患者再予静脉输注右旋糖酐氢氧化铁，每次100mg，每周2次，共10次。观察治疗前后血红蛋白（Hb）、红细胞压积(Hct)、血清铁蛋白(SF)及转铁蛋白饱和度(TSAT)，以及静脉补铁后Hb、Hct、SF、TSAT的动态变化。结果口服补铁组临床有效率21％，胃肠道副作用明显（10/24，占41.67%），纠正缺铁的维持时间短。静脉补铁组有效率70.8 ％，副作用少（胃肠道副作用1/24，占0.04%；轻度肌肉痛1/24，占0.04%），纠正缺铁的维持时间长。结论 CRF贫血患者静脉补铁优于口服补铁。 

Abstract

Objective Iron deficiency is common in hemodialysis patients suffered from chronic renal failure(CRF). It caused anemia and influenced the efficiency of eythropoietin. Hemodialysis patients were traditionally treated with oral iron, because of the gastrointestinal side effects, they were now advised to be supplied with intravenous iron. Methods Twenty-four hemodialysis patients were studied, They were given oral iron（Ferrous succinate, namely SuLiFei） firstly and then intravenous iron（iron dextran，namely Cosmofer）. Iron deficiency, improvement, result and side effect were monitored. The oral dosage of Ferrous succinate was 200mg dose, 3 times a day for 2 month. After washing out for 2 months. Then these patients were givenintravenous iron dextran with a dosage of 100mg twice a week for 5 weeks. During the treatment、Hemoglobin（Hb）、Hematocrit (Hct)、serum ferritin(SF) and trasferrin saturation (TSAT) were monitored. Results The efficacy of oral iron is 21％ which can maintain iron balance for only a short period of time with gastrointestinal side effects（10 out of 24 patient, 41.67%）. The efficacy of intravenous iron is 70.8％ which can maintain longer iron balance minimal side effects（only 1 out of 24 have gastrointestinal side effect, 0.04%; one case of slight courbature, 0.04%）. Conclusion Intravenous iron supplement is better than oral iron.