中国血液净化

›› 2004, Vol. 3 ›› Issue (5): 254-260.

• 论著 • 上一篇    下一篇

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

袁群生 郑法雷   

  1. 100730 北京，中国医学科学院、中国协和医科大学、北京协和医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2004-05-12 发布日期:2004-05-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2004-05-12 Published:2004-05-12

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摘要：

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。25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，100mg蔗糖铁注射液稀释于100 ml生理盐水，透析中静脉滴注，每周一次，共10次，总补铁量1 000mg；②口服组12例，琥珀酸亚铁200mg 每日3次，共10周。两组患者均联合EPO治疗，剂量为100～180 U/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 (reticulocyte hemoglobin content, CHr)、低色素红细胞百分比(percentage of hypochromic red blood cells, %HRC)、血清铁蛋白(serum ferritin, SF)和转铁蛋白饱和度(transferritin saturation, 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、CHr、SF和TS于治疗4周后均明显升高，%HRC明显降低；口服组Hb和Hct于治疗6周后明显升高。治疗结束时，静脉组Hb由治疗前的(78.5±5.9)g/L升至(104.4±8.1)g/L( P<0.001)，Hct由23.6%±1.7%升至31.4%±2.5% (P<0.001)，CHr由(27.1±1.2)pg升至 (29.9±1.5) pg ( P<0.001)，SF由 (211±71) μg/L升至 (283±62) μg/L (P<0.01); TS由13.3%±3.4%升至20.0%±2.9%（P<0.01），HRC从5.7%±3.1%降至2.6%±1.2% (P<0.001)；口服组 Hb由 (79.2±6.0) 升至 (96.3±5.5) g/L(P<0.001)；Hct由23.7%±1.8%升至29.1%±1.6% (P<0.001)。治疗结束时，静脉组 Hb、Hct、CHr、SF和TS均明显高于口服组［Hb：(104.4±8.1)g/L vs (96.3±5.5)g/L, (P<0.01)； Hct：31.4%±2.5% vs 29.1%±1.6%,(P<0.05)；CHr：(29.9±1.5)pg vs (27.7 ± 1.6)pg, (P<0.01); SF: (283±62)μg/L vs(221±57)μg/L，(P<0.05)；TS：20.0% ± 2.9% vs 14.4% ± 3.5%, P<0.01］；% HRC明显低于口服组2.6%±1.2% vs 4.4%±1.6%, (P<0.01)。两组平均 EPO剂量无显著性差异［静脉组：(141±11)U/kg/week vs 口服组：(136±16)U/kg/week,P>0.05］。治疗后两组患者血清 BUN、Cr、ALT、AST、Tbil、Alb、CRP、叶酸和VitaminB12等均无明显变化。结论 血液透析患者，即使铁储备正常，若存在功能性缺铁，仍需静脉补铁。与口服铁剂琥珀酸亚铁比较，蔗糖铁注射液可更好地纠正透析患者的功能性缺铁，增加铁储备，改善EPO的疗效。

关键词: 铁剂, 红细胞生成素, 功能性缺铁, 血液透析, 贫血

Abstract:

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, VitaminB12, 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.

Key words: EPO, Functional iron deficiency, Hemodialysis, Anemia

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