中国血液净化

›› 2007, Vol. 6 ›› Issue (3): 134-137.

• 论著 • 上一篇    下一篇

不同补铁方法对维持性血液透析患者贫血、炎症及氧化应激的影响

王 悦 阿拉塔 崔 专 史钧宝 杨文领 王 松 张爱华 郑丹侠 朱 宁 范敏华   

  1. 100083 北京，北京大学第三医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-03-12 发布日期:2007-03-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-03-12 Published:2007-03-12

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摘要： 目的 探讨维持性血液透析患者由口服铁剂改为静脉铁剂前后贫血、炎症及氧化应激反应的变化。方法 选择北京大学第三医院肾内科72名维持性血液透析患者，服速立菲0.6g/d、注射重组人促红细胞生成素(rHuEPO)(9 000～12 000)IU/w 2年半以上，血红蛋白(Hb)仍低于100g/L，改为静脉点滴科莫非或森铁能100mg(每次透析时)至预计总缺铁量，然后每2～3周静脉点滴100mg维持24个月以上，如果Hb大于130g/L减1/4 rHuEPO用量，回顾分析口服治疗和静脉治疗初、12个月和24个月连续3个月患者Hb、血清转铁蛋白饱和度(TSAT)、铁蛋白(SF)、rHuEPO用量，以及血清白介素6(IL-6)、肿瘤坏死因子α(TNFα)、C反应蛋白(CRP)、丙二醛(MDA)的变化。结果 口服治疗2年中，患者平均rHuEPO 用量(9863±655)IU/w，Hb(95.60±9.74)g/L，TSAT(15.30±2.45)%，治疗初、12个月、24个月比较差异均无显著性 (P＜0.05)。改用静脉铁剂后2年中，患者平均rHuEPO用量减少至(7 416±437)IU/w，Hb上升至(122.60±11.60)g/L, TSAT上升至(31.30±3.35)%，与口服铁剂相比差异均有显著性(P＜0.05)，其中治疗12个月和24个月较治疗初差异均有显著性(P＜0.05)，但治疗24个月较12个月差异无显著性(P＞0.05)。IL-6、TNFa在口服或静脉补铁期间、改用静脉铁剂前后变化均无显著性(P＞0.05)，MDA在口服铁剂期间变化无显著性，平均值(7.83±4.85)ng/ml，改为静脉铁剂后上升至(13.42±7.15)ng/ml (P＜0.05)，其中治疗12个月较治疗初显著升高 (P＜0.05)，24个月较12个月差异无显著性(P＞0.05)。SF在改用静脉铁剂前后变化无显著性(P＞0.05)。结论 维持性血液透析患者由口服铁改为静脉铁2年后贫血纠正，铁缺乏改善，炎症反应无明显变化，氧化应激反应加重。

关键词: 透析患者, 铁剂, 血红蛋白, 炎症状态, 过氧化反应

Abstract: Objective To investigate the changes of hemoglobin(HB), inflammation and oxidative stress in hemodialysis patients before and after alternation from oral iron to intravenous iron. Methods Seventy-two dialysis patients, treated with enteral iron saccharate of 600mg daily and recombinant human erythropoietin (rHuEPO) of 100-150IU/w weekly with HB level lower than 100.0g/L for last two and a half years, were switched to intravenous iron therapy. Intravenous iron was first pumped at the dose of 100mg during each dialysis session to a total amount calculated by following formula: Iron amount = body weight (Kg)150-measured HB (g/L)] 0.24+500(mg) and then supplemented at the dose of 100mg bi-weekly. HB, transferrin saturation(TSAT), ferritin, interleukin-6 (IL-6), tumor necrosis factor (TNF ), C reactive protein(CRP), meleic dialdehyte malondialdehyde (MDA) were retrospectively analyzed at the beginning, the end of the first and the second year of each preparation for consecutive three months. One fourth of the dose of rHuEPO was reduced when HB level was above 130g/L. Results During the 2 years treated with oral iron, dose of rHuEPO administered was (9863 655) unit/week, HB was (95.60 9.74)g/L，TSAT was (15.30 2.45)%，no significance was found among initials, the end of the first and the second year of treatment (P ＞0.05), During the 2 years treated with intravenous iron, dose of rHuEPO decreased to (7416 437)unit/week, HB increased to (122.60 11.60) g/L, TSAT increased to (31.30 3.35)%, there were significant differences of these parameters between intravenous iron and oral iron therapy, at the end of the first and the second year of intravenous iron therapy and at the initial of intravenous iron therapy (P＜0.05), but no significant difference between those at the end of the first year and the end of the second year of intravenous iron therapy (P＞0.05). IL-6, TNF- and ferritin had no significant change during the whole observation, but MDA was increased from (7.83 4.85) ng/ml to (13.42 7.15) ng/ml in after intravenous iron therapy (P＜0.05). Conclusion In maintained hemodialysis patients, iron deficiency and anemia were improved, and peroxidation was aggregated but inflammation had no significant deterioration after alteration from oral iron to intravenous iron.

Key words: Iron, Hemoglobin, Inflammation state, Peroxidation

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