中国血液净化

›› 2010, Vol. 9 ›› Issue (9): 482-485.doi: 10.3969/j.issn.1671-4091.2010.09.00

• 临床研究 • 上一篇    下一篇

维持性血液透析患者铁代谢状况的初步分析

李 寒 王世相   

  1. 首都医科大学附属北京朝阳医院血液净化中心
  • 收稿日期:2010-04-26 修回日期:1900-01-01 出版日期:2010-09-12 发布日期:2010-09-12

Iron metabolism state in maintenancehemo dialysis patients

LI Han, WANG Shi-xiang   

  1. Blood Purification Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing 10020, China
  • Received:2010-04-26 Revised:1900-01-01 Online:2010-09-12 Published:2010-09-12

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摘要：
【摘要】目的 调查维持性血液透析患者铁代谢的情况。方法 采用横断面研究。以首都医科大学附属北京朝阳医院血液净化中心76例维持性透析患者为研究对象，收集患者临床资料、血清铁代谢指标、血常规、铁剂和促红细胞生成素应用情况，分析患者铁代谢状态及其与铁剂应用情况的关系。结果 76例维持性血液透析患者中有36例(47.4%)存在铁缺乏，其中功能性铁缺乏23例、绝对铁缺乏13例，患病率分别为30.3%和17.1%。76例维持性血液透析患者中，血清铁蛋白＜200 靏/L者17例、200～800 靏/L者40例、＞800 靏/L者19例，其发生率分别为22.4%、52.6%和25.0%。血清铁蛋白＞800 靏/L的19例透析患者中有4例合并有功能性铁缺乏，其患病率为21.1%。铁缺乏与无铁缺乏患者的血红蛋白水平分别为(110.2±13.3)g/L和(111.3±10.9)g/L，二者相比差异无统计学意义(t=0.388,P=0.699)；但存在铁缺乏的透析患者每周促红细胞生成素用量明显高于无铁缺乏的透析患者，分别为(7675.9±2108.9)U和(6429.1±1947.3)U，差异有统计学意义(t = 2.680,P=0.009)。76例维持性血液透析患者中，使用静脉铁剂者25例，使用口服铁剂者51例。使用静脉铁剂者铁缺乏的患病率明显低于口服铁剂者，但使用静脉铁剂者血清铁蛋白＞800 靏/L的发生率明显高于口服铁剂者，差异均有统计学意义(P＜0.05)。结论 维持性血液透析患者铁缺乏的发生率较高，主要表现为功能性铁缺乏。存在铁缺乏的透析患者须用较大剂量的促红细胞生成素方可维持其血红蛋白水平。使用静脉铁剂虽可减少铁缺乏的发生，但可能引起血清铁蛋白过高。

关键词: 肾透析, 贫血, 铁代谢

Abstract: Objective To investigate the status of iron metabolism in maintenance hemodialysis (MHD) patients. Methods Seventy-six patients on MHD were involved in this cross-sectional study. The following data were collected: clinic data, serum ferritin and transferrin saturation, hemoglobin, and treatment of iron and erythropoietin preparations. t test and Chi-square test were used for statistical analyses. Results Among the 76 MHD patients, 36 (47.4%) MHD patients had iron deficiency. The prevalence of functional and absolute iron deficiency was 30.3% and 17.1%, respectively. The prevalence of serum ferritin <200ug/L, 200～800 ug/L, and >800ug/L was 22.4%, 52.6% and 25.0%, respectively. Four (21.1%) in 19 MHD patients with serum ferritin >800ug/L had functional iron deficiency. The level of hemoglobin in MHD patients with iron deficiency was (110.2±13.3)g/L, similar to the hemoglobin level of (111.3±10.9)g/L in MHD patients without iron deficiency. But the total EPO dose per week was significantly higher in MHD with iron deficiency than in MHD patients without iron deficiency [(7675.9±2108.9)U vs. (6429.1±1947.3)U, t=2.680, P=0.009]. The prevalence of iron deficiency was significantly lower and the prevalence of serum ferritin >800ug/L was significantly higher, in MHD patients receiving intravenous iron than in MHD patients receiving oral iron preparations. Conclusions The prevalence of iron deficiency in MHD patients was relatively high. The iron deficiency pattern was predominantly functional iron deficiency. The MHD patients with iron deficiency must be treated with higher dose of EPO to maintain their hemoglobin level. Intravenous iron administration was an effective method to reduce the prevalence of iron deficiency, but may result in the increase of serum ferrtin in MHD patients.

Key words: Anemia, Iron