静脉铁剂治疗血液透析患者肾性贫血的临床疗效和安全性

目的：比较静脉注射右旋糖酐铁和口服硫酸亚铁分别与重组人红细胞生成素（rhEPO）联合应用，治疗伴有缺铁的血液透析患者肾性贫血的有效性和安全性。方法：采用前瞻性、随机、对照的研究方法把90例血透患者分为静脉组和口服组，每组各45例。静脉组患者每次透析时使用100mg右旋糖酐铁，直至完成总预计补铁量。口服组患者服用硫酸亚铁525mg，1次／d，共8周。两组患者均使用rhEPO治疗，剂量为每周120～150U／kg。观察并比较两组患者贫血治疗的效果、铁代谢指标的变化及不良反应发生情况。结果：治疗前静脉组与口服组在男女性别比例、年龄、体重和维持性透析时间及血红蛋白（Hb）、铁蛋白和转铁蛋白饱和度等方面均无显著差异。治疗后静脉组和口服组Hb均较治疗前明显升高（P〈0．001）．而静脉组Hb上升幅度明显高于口服组，上升速度明显快于口服组（P〈0．01）。两组患者平均rhEPO用量无差异。两组患者治疗后铁蛋白和转铁蛋白饱和度均明显高于治疗前，治疗后静脉组铁蛋白和转铁蛋白饱和度均明显高于口服组（P〈0．001）。两组患者治疗前后血清Bun、Scr、AST、AlP、Alb和CRP等均无明显变化，无严重不良反应发生，但静脉组不良反应发生率明显低于口服组（P=0．016）。结论：右旋糖酐铁能安全有效地纠治接受rhEPO治疗的血液透析患者的肾性贫血，疗效优于口服铁剂，且不良反应发生率更低。

Effectiveness and safety of intravenous iron supplementation in patients with renal anaemia on hemodialysis

Objective: To determine and compare the effectiveness and safety of intravenous iron supplementation with oral ferrous sulfate in hemodialysis patients treated with recombinant human erythropoietin (rhEPO). Methods: Ninety hemodialy-sis patients were divided into two groups. In intravenous group, patients were given iron dextran 100 mg intravenously during each hemodialysis session. In oral group, patients were given ferrous sulfate 525 mg one time per day for 8 weeks. Each patient of both groups received rhEPO 120-150 U/kg per week. The efficacy was assessed by the changes in Hb, ferritin and transfer-rin saturation values. Results: There were no differences between intravenous and oral groups in sex. age, body weight, duration of hemodialysis, Hb values, ferritin and transferrin saturation before treatment. At the end of the trial,the Hb levels of both groups significantly increased, but the increasing rate in intravenous group was markedly higher than that in oral group (P<0. 01). There was no difference in average dosage of rhEPO between two groups. The levels of ferritin and transferrin saturation significantly increased after treatment in both groups, but the levels of ferritin and transferrin saturation in intravenous group were higher than those in oral group, respectively (P<0. 001). The serum levels of Scr, Bun, AST, A1P, Alb and CRP in both groups did not change significantly. There were no severe adverse events in both groups, and the incidence of adverse events in intravenous group was lower than that in oral group (P = 0. 016). Conclusion:The intravenous iron supplementation may induce Hb level to rise faster with less adverse events and its amount needed for patients can be evaluated more accurately than oral ferrous preparation.