缺铁性贫血患者口服铁剂须知

<正>缺铁性贫血是常见病,目前临床上常用的口服铁剂有硫酸亚铁、富马酸亚铁(富血铁)、多糖铁复合物(力蜚能)、琥珀酸亚铁(速力菲)、硫酸亚铁控释片(施乐菲)、维铁缓释片(福乃得)等。其中硫酸亚铁价廉有效,后几种口服铁剂的治疗效果好,不良反应少,已成为缺铁性贫血患者常用的口服铁剂。以下将缺铁性贫血口服铁剂的有关问题做一简要回答。口服铁剂要同时加服维生素C吗?缺铁性贫血患者在服用铁剂的C     

含铁制剂的选择

缺铁性贫血是临床常见病，常伴有皮肤黏膜苍白、倦怠乏力、头晕、心悸、体力活动后气促、指甲薄脆或匙状甲、异食癖等临床症状。临床上一旦确诊，除治疗原发病外，还应进行补铁治疗。 药用铁剂有两大类：无机铁，有机铁。无机铁主要为硫酸亚铁；有机铁剂有琥珀酸亚铁、葡萄糖酸亚铁、枸橼酸铁铵、山梨醇铁、含糖铁、富马酸亚铁、右旋糖酐铁和多糖铁复合物。     

补血药的合理应用

<正>当前,补血药品种繁多,大致可分为以下几大类:铁剂、维生素类、肾上腺皮质激素类、雄激素类等。合理应用补血药具有重要临床意义。铁剂主要用于缺铁性贫血的预防和辅助治疗。目前药房出售的铁剂,主要有硫酸亚铁、富马酸亚铁、葡萄糖酸亚铁、右旋糖酐铁、琥珀酸亚铁、多糖铁复合物等,其中硫酸亚铁属无机铁,其他均为有机铁。此外,还有不少补铁中药制剂,如血宝胶囊、血宝口服液、红衣补血口服液、维血冲剂等。     

贫困地区小儿缺铁性贫血铁剂治疗的经济选择

目的:为贫困地区合理选用铁剂治疗小儿缺铁性贫血提供参考依据。方法:选择伊犁市场6种铁剂,以1岁小儿为例,计算出1个疗程所需每种铁剂总量的费用,并进行药物经济学最小成本分析。结果:费用从高到低依次为佳佳铁、阿胶铁、速力菲、右旋糖酐铁、贫血康、硫酸亚铁。结论:药物经济学分析推荐贫困地区基层药房备用硫酸亚铁片、琥珀酸亚铁。     

应用铁剂的注意事项

贫血是指血液中红血球数量太少,血红素不足。根据病因,医学上将其分为“缺铁性贫血”“、巨幼红细胞性贫血”和“溶血性贫血”等,而以“缺铁性贫血”最为常见。缺铁性贫血的治疗,以口服或注射铁剂为最常用,也最有效。笔者在临床工作中经常遇到各类病人,询问如下问题:我口服铁剂已几年了,但化验结果仍是贫血,后来加大了剂量,但仍无效果,到底为什么……要知道,应用铁剂还有许多注意事项。1!口服铁剂以硫酸亚铁、富马酸亚铁和葡萄糖酸亚铁为佳,因为铁以二价铁(亚铁)的形式吸收,三价铁(正铁)的形式起作用。2"贫血补铁应坚持“小量、长期”的原则…     

服用铁剂五不宜

铁剂常用于治疗慢性失血、营养不良、妊娠、儿童生长期所引起的缺铁性贫血,常用的铁剂有硫酸亚铁、葡萄糖酸亚铁、富马酸亚铁、琥珀酸亚铁等,在服用时要注意以下五点。     

小儿推拿疗法联合硫酸亚铁治疗小儿缺铁性贫血的临床疗效观察

目的探讨推拿疗法联合硫酸亚铁对小儿缺铁性贫血的临床疗效。方法将120例诊断为轻、中度缺铁性贫血的患儿按照随机数字表法分为治疗组和对照组,治疗组采用中医小儿推拿治疗的同时给予硫酸亚铁口服,对照组单纯口服硫酸亚铁,连续4周,观察治疗前后血红蛋白(Hb)、血清铁、铁蛋白、总铁结合力水平变化,同时观察不良反应的情况。结果经治疗后,治疗组对缺铁性贫血的治疗优于对照组,两组总有效率比较,差异有统计学意义(P<0.05);治疗组对缺铁性贫血的治疗优于对照组(P<0.01);治疗组与对照组对血清铁、铁蛋白及总铁结合力水平与治疗前比较,差异有统计学意义(P<0.01),两组之间对血清铁、铁蛋白、总铁结合力的变化水平比较,差异无统计学意义(P>0.05);对照组不良反应发生率高于治疗组(P<0.05)。结论小儿推拿疗法联合铁剂治疗小儿缺铁性贫血疗效显著,可降低不良反应发生率,方便易行。     

多糖铁复合物与膳食指导对孕妇IDA的疗效观察

目的观察多糖铁复合物和膳食指导对孕妇缺铁性贫血(IDA)的疗效。方法 164例确诊为缺铁性贫血孕妇分为两组:多糖铁复合物组(118例)和非药物干预的膳食指导组(46例),随访12周。观察孕妇的血红蛋白(Hb)变化、临床症状以及不良反应。结果经铁剂治疗4周及8周后,多糖铁复合物组血红蛋白明显上升并高于膳食指导组(P<0.01),治疗8周时多糖铁复合物组总有效率为88.6%,膳食指导组28例(66.7%)血红蛋白无明显改善。多糖铁复合物组不良反应发生率为2.5%。结论多糖铁复合物可以治疗孕妇缺铁性贫血,不良反应轻。膳食指导不能治愈孕期缺铁性贫血。     

右旋糖酐铁与硫酸亚铁治疗缺铁性贫血患儿的效果

目的比较右旋糖酐铁与硫酸亚铁治疗缺铁性贫血患儿的临床效果。方法选取2018年1月至2020年1月医院收治的88例缺铁性贫血患儿作为研究对象,按随机数字表法分为对照组与试验组,各44例。两组均予以饮食指导并口服维生素C,在此基础上,对照组服用硫酸亚铁治疗,试验组服用右旋糖酐铁治疗,比较两组血常规指标、铁代谢指标及不良反应发生情况。结果治疗后,试验组血红蛋白(Hb)水平、平均血红蛋白浓度(MCHC)、平均红细胞体积(MCV)、血清铁(SI)及血清铁蛋白(SF)水平均高于对照组,血清转铁蛋白(TF)水平及不良反应发生率均低于对照组,差异有统计学意义(P<0.05)。结论右旋糖酐铁治疗可提高缺铁性贫血患儿的血常规指标水平,调节机体铁代谢,加快贫血症状缓解,安全可靠。     

注射右旋糖酐铁致过敏性休克1例报告

注射右旋糖酐铁致过敏性休克１例报告江苏省徐州电厂医院（２２１１６６）周显民１病例介绍患者赵某，女，４２岁。头痛、头晕半年余，近日发现脸色苍白，头晕加重。外院检查：血红蛋白６０克／升，诊断为缺铁性贫血。因患有消化性溃疡无法口服铁剂而采用右旋糖酐铁肌肉注...     

Comparison of ferrous sulfate and ferrous glycinate chelate for the treatment of iron deficiency anemia in gastrectomized patients

OBJECTIVES: Postgastrectomy iron deficiency anemia has a variable prevalence and occurs in 20-50% of patients. Food fortification reports examining ferrous glycinate chelate have shown that it can be 2.5-3.4 times more bioavailable than ferrous sulfate, with minimal gastrointestinal symptoms. The present study was designed as a controlled experimental study including 18 gastrectomized patients with iron deficiency anemia to compare the effects of ferrous sulfate and ferrous glycinate chelate in the treatment of anemia and to evaluate the presence of side effects. METHODS: Patients were divided in two groups: group 1 received ferrous sulfate (200 mg twice a day, corresponding to 80 mg of elemental iron) and group 2 received ferrous glycinate chelate (250 mg/d, corresponding to 50 mg of elemental iron) for 4 mo. Laboratory measurements were performed at baseline and after 2 and 4 mo. RESULTS: Group 1 showed an apparent recovery in laboratory parameters, with increases in medium corpuscular hemoglobin (P = 0.02), serum iron (P = 0.02), and ferritin (P = 0.04), and a decrease in transferrin (P = 0.002) after 4 mo. Individualized analysis showed that only one patient using ferrous sulfate had anemia at the end of the study in contrast to six patients using ferrous glycinate. In addition, ferritin levels increased above 20 microg/L at the end of the study in seven patients using ferrous sulfate in contrast to one patient using ferrous glycinate. CONCLUSION: Patients with iron deficiency anemia after gastrectomy treated with ferrous sulfate had better results in hematologic laboratory parameters than those who used ferrous glycinate chelate.     

Helicobacter pylori infection, iron absorption, and gastric acid secretion in Bangladeshi children

BACKGROUND: Nonheme-iron absorption requires an acidic milieu. Reduced gastric acid output as a consequence of Helicobacter pylori infection could be an important limiting factor for iron absorption. OBJECTIVE: We measured gastric acid output and iron absorption from a non-water-soluble iron compound (ferrous fumarate) and a water-soluble iron compound (ferrous sulfate) in children with and without H. pylori infection. DESIGN: Gastric acid output was quantified before (basal acid output, or BAO) and after pentagastrin stimulation (stimulated acid output, or SAO) in 2-5-y-old children with iron deficiency anemia who were (n = 13) or were not (n = 12) infected with H. pylori. Iron absorption was measured by using a double-stable-isotope technique. H. pylori-infected children were studied before and after eradication therapy. RESULTS: BAO and SAO were significantly lower in the H. pylori-infected children (0.2 +/- 0.2 and 1.6 +/- 0.9 mmol/h, respectively) than in the uninfected children (0.9 +/- 0.7 and 3.1 +/- 0.9 mmol/h, respectively; P = 0.01 and P < 0.005). BAO and SAO improved to 0.8 +/- 1.3 and 3.3 +/- 2.4 mmol/h, respectively, after therapy. Iron absorption from ferrous sulfate was significantly greater than that from ferrous fumarate both before (geometric : 19.7% compared with 5.3%; P < 0.0001) and after (22.5% compared with 6.4%; P < 0.0001) treatment in H. pylori-infected children. Corresponding values for uninfected children were 15.6% and 5.4%, respectively (P < 0.001; n = 12). CONCLUSIONS: Iron absorption from ferrous fumarate was significantly lower than that from ferrous sulfate in both H. pylori-infected and uninfected Bangladeshi children. Treatment of H. pylori infection improved gastric acid output but did not significantly influence iron absorption. The efficacy of ferrous fumarate in iron fortification programs to prevent iron deficiency in young children should be evaluated.     

几种红细胞和铁参数在儿童缺铁性贫血和溶血性贫血中的比较

目的:研究多种红细胞和铁参数在缺铁性贫血和溶血性贫血中的不同变化,了解它们在二者中有无鉴别意义。方法:采用全自动血细胞分析仪做血常规及红细胞分析,血液荧光测定仪测定锌原卟啉,EIA法测定血清转铁蛋白受体,检测了40例缺铁性贫血患儿(Hb 62.6±20.8 g/L)和33例溶血性贫血患儿(Hb 58.5±21.6 g/L),包括15例β-地中海贫血(仅1例为轻型)。结果:缺铁性贫血和各种溶血性贫血的红细胞分布宽度(RDW)、锌原卟啉(ZPP)、血清转铁蛋白受体(sTfR)均增高。RDW-SD在各种溶血性贫血均显著高于缺铁性贫血,P均<0.01;RDW-CV只在β-地中海贫血明显高于缺铁性贫血,P<0.01,而其他溶血性贫血的RDW-CV值却和缺铁性贫血非常相似(P=0.998)。缺铁性贫血的ZPP明显高于溶血性贫血,P<0.01。sTfR在β-地中海贫血高于缺铁性贫血和其他类型溶血性贫血,P均<0.05;不同的溶血性贫血sTfR升高的程度不同。结论:虽然缺铁性贫血和溶血性贫血的红细胞分布宽度、ZPP、sTfR均增高,但程度并不一致,可根据以上变化将二者区别开来。在评价溶血性贫血的sTfR水平时,应首先考虑溶血性贫血的类型。     

北京市东城区3至6个月婴儿铁缺乏影响因素的分析

目的了解北京市东城区3～6个月婴儿贫血、铁缺乏和缺铁性贫血的患病情况,并筛选其影响因素。方法选择2010年12月至2011年10月在北京市东城区和平里医院进行卡介苗接种的签署知情同意的854名3～6个月婴儿及其家庭的基本情况进行问卷调查,基本内容包括婴儿的月龄、性别、出生身长、出生体重等信息,对婴儿及其母亲进行实验室相关项目的检测：婴儿的血红蛋白（Hb）、平均红细胞体积（MCV）、平均红细胞血红蛋白含量（MCH）、平均红细胞血红蛋白浓度（MCHC）、和全血铁元素含量、血液锌原卟啉（ZPP）、血清铁蛋白（SF）的测定、母亲的血红蛋白、血清铁蛋白、血清铁（SI）。分析营养性贫血的患病情况,并采用非条件logistic回归模型筛选婴儿贫血的相关影响因素。结果北京市东城区3～6个月龄婴儿贫血、铁缺乏和缺铁性贫血的患病率分别为12．06％、7．38％和2．11％,非条件logistic回归分析显示：婴儿的月龄4～5个月（OR=0．496,95％CI：0．272～0．905）是贫血的影响因素;婴儿的月龄5～6个月（OR=0．334,95％CI：0．125～0．891）和第1次吃奶时间（第2天）（OR=2．359,95％CI：1．191～4．675）是铁缺乏的影响因素。结论北京市东城区3～6个月婴儿的铁营养状况有所好转,月龄和开奶时间均可影响婴儿的铁营养状况。     

长期静脉补铁改善血液透析患者肾性贫血的作用

目的探讨血液透析患者长期静脉补铁改善肾性贫血的效果以及对促红细胞生成素(EPO)作用的影响。方法选择56例病情稳定的血液透析患者随机分成两组:静脉组和口服组,各28例,疗程6个月。静脉组:于每次透析时补给100mg右旋糖酐铁,共10次,然后每2周给予维持量100mg。口服组:前3个月口服硫酸亚铁525mg/d,后3个月停服,按上述方法改用静脉补铁。比较两组贫血治疗效果、铁代谢和生化指标的变化、EPO用量以及不良反应发生情况。结果治疗后静脉组血红蛋白(Hb)、红细胞压积(Hct)、血清铁蛋白(SF)、转铁蛋白饱合度(TSAT)进行性升高,3个月后80%以上的患者贫血得到纠正,EPO用量较基数减少约28%。口服组治疗3个月时,Hb和Hct增幅不大,而SF和TSAT则逐月降低;第4个月起改用静脉补铁后,SF、TSAT很快升高,贫血迅速得到改善,EPO用量开始明显减少。结论长期静脉补铁不仅能及时有效地改善血液透析患者的贫血,减少EPO用量,而且经济、安全。     

Efficacy and tolerability of low-dose iron supplements during pregnancy: a randomized controlled trial

BACKGROUND: Iron deficiency anemia (IDA) is common in pregnant women, but previous trials aimed at preventing IDA used high-dose iron supplements that are known to cause gastrointestinal side effects. OBJECTIVE: The objective was to assess the effect on maternal IDA and iron deficiency (ID, without anemia) of supplementing pregnant women with a low dosage (20 mg/d) of iron. Effects on iron status were assessed at the time of delivery and at 6 mo postpartum. Gastrointestinal side effects were assessed at 24 and 36 wk of gestation. DESIGN: This was a randomized, double-blind, placebo-controlled trial of a 20-mg daily iron supplement (ferrous sulfate) given from 20 wk of gestation until delivery. RESULTS: A total of 430 women were enrolled, and 386 (89.7%) completed the follow-up to 6 mo postpartum. At delivery, fewer women from the iron-supplemented group than from the placebo group had IDA [6/198, or 3%, compared with 20/185, or 11%; relative risk (RR): 0.28; 95% CI: 0.12, 0.68; P < 0.005], and fewer women from the iron-supplemented group had ID (65/186, or 35%, compared with 102/176, or 58%; RR: 0.60; 95% CI: 0.48, 0.76; P < 0.001). There was no significant difference in gastrointestinal side effects between groups. At 6 mo postpartum, fewer women from the iron-supplemented group had ID (31/190, or 16%, compared with 51/177, or 29%; RR: 0.57; 95% CI: 0.38, 0.84; P < 0.005). The rate of IDA between the groups did not differ significantly at 6 mo postpartum. CONCLUSION: Supplementing the diet of women with 20 mg Fe/d from week 20 of pregnancy until delivery is an effective strategy for preventing IDA and ID without side effects.     

Maize Porridge Enriched with a Micronutrient Powder Containing Low-Dose Iron as NaFeEDTA but Not Amaranth Grain Flour Reduces Anemia and Iron Deficiency in Kenyan Preschool Children

Few studies have evaluated the impact of fortification with iron-rich foods such as amaranth grain and multi-micronutrient powder (MNP) containing low doses of highly bioavailable iron to control iron deficiency anemia (IDA) in children. We assessed the efficacy of maize porridge enriched with amaranth grain or MNP to reduce IDA in Kenyan preschool children. In a 16-wk intervention trial, children (n = 279; 12-59 mo) were randomly assigned to: unrefined maize porridge (control; 4.1 mg of iron/meal; phytate:iron molar ratio 5:1); unrefined maize (30%) and amaranth grain (70%) porridge (amaranth group; 23 mg of iron/meal; phytate:iron molar ratio 3:1); or unrefined maize porridge with MNP (MNP group; 6.6 mg iron/meal; phytate:iron molar ratio 2.6:1; 2.5 mg iron as NaFeEDTA). Primary outcomes were anemia and iron status with treatment effects estimated relative to control. At baseline, 38% were anemic and 30% iron deficient. Consumption of MNP reduced the prevalence of anemia [-46% (95% CI: -67, -12)], iron deficiency [-70% (95% CI: -89, -16)], and IDA [-75% (95% CI: -92, -20)]. The soluble transferrin receptor [-10% (95% CI: -16, -4)] concentration was lower, whereas the hemoglobin (Hb) [2.7 g/L (95% CI: 0.4, 5.1)] and plasma ferritin [40% (95% CI: 10, 95)] concentrations increased in the MNP group. There was no significant change in Hb or iron status in the amaranth group. Consumption of maize porridge fortified with low-dose, highly bioavailable iron MNP can reduce the prevalence of IDA in preschool children. In contrast, fortification with amaranth grain did not improve iron status despite a large increase in iron intake, likely due to high ratio of phytic acid:iron in the meal.     

Relationship of vitamin A deficiency, iron deficiency, and inflammation to anemia among preschool children in the Republic of the Marshall Islands

INTRODUCTION: Although vitamin A deficiency, iron deficiency, and inflammation may contribute to anemia, their relative contribution to anemia has not been well characterized in preschool children in developing countries. OBJECTIVE: To characterize the contributions of vitamin A and iron deficiencies and inflammation to anemia among preschool children in the Republic of the Marshall Islands. SUBJECTS AND METHODS: A community-based survey, the Republic of the Marshall Islands Vitamin A Deficiency Study, was conducted among 919 preschool children. The relationship of vitamin A and iron status and markers of inflammation, tumor necrosis factor-alpha, alpha1-acid glycoprotein, and interleukin-10, to anemia were studied in a subsample of 367 children. RESULTS: Among the 367 children, the prevalence of anemia was 42.5%. The prevalence of severe vitamin A deficiency (serum vitamin A < 0.35 micromol/l) and iron deficiency (serum ferritin < 12 microg/dl) were 10.9 and 51.7%, respectively. The respective prevalence of iron deficiency anemia (hemoglobin < 110 g/l and iron deficiency), anemia with inflammation (anemia with TNF-alpha > 2 pg/ml and/or AGP > 1000 mg/l), and severe vitamin A deficiency combined with anemia was 26.7, 35.6, and 7.6%. In multivariate linear regression models that adjusted for age, sex, and inflammation, both iron deficiency (odds ratio (OR) 1.74, 95% confidence interval (CI) 1.08-2.83, P = 0.023) and severe vitamin A deficiency (OR 4.85, 95% CI 2.14-10.9, P < 0.0001) were significantly associated with anemia. CONCLUSIONS: Both iron and vitamin A deficiencies were independent risk factors for anemia, but inflammation was not a significant risk factor for anemia among these preschool children.     

北京山区学龄儿童铁营养状况及亚临床铁缺乏的干预效果

目的　调查北京山区学龄儿童机体铁营养状况、亚临床铁缺乏 (SID)患病率及观察采用乙二胺四乙酸钠铁 (NaFeEDTA)间断补充与早期铁干预效果。方法　对北京市房山山区 7～ 13岁学龄儿童 10 12名进行膳食调查、膳食频率调查与体内铁生化指标检测 ,依现行标准筛检贮存铁减少(IDs)、红细胞生成缺铁 (IDE)和缺铁性贫血 (IDA)儿童共 2 6 7名 ,给予口服NaFeEDTA胶囊 ( 6 0mgFe/粒 ) ,每次 1粒 ,IDs与IDE儿童 ,每周 1次 ;IDA儿童每周 3次 ,连续 9周。重复测定体内铁生化指标 ,并与干预前进行比较。结果　各年龄组儿童能量、蛋白质、铁和维生素C平均每日摄入量均达到推荐的膳食营养素摄入量 ,但膳食铁构成中血红素铁所占比例较低 ;该人群血液铁生化指标检测平均值 :血清铁蛋白含量为 ( 5 0 83± 33 0 9) μg/L ,红细胞游离原卟啉 (FEP)含量为 ( 489 44± 2 19 6 1) μg/L ,FEP/血红蛋白 (Hb)比值为 ( 3 83± 1 96 ) ,Hb含量为 ( 130 5 7± 10 82 )g/L ;总铁缺乏 (IDs+IDE +IDA)儿童检出率为 2 6 5 %,其中IDs占 15 5 %,IDE占 7 1%,IDA占 3 9%,SID占缺铁总人数的 85 4%,为IDA儿童的 5 8倍。进行铁干预后 ,体内各项铁指标显著提高并恢复至正常水平。结论　SID是值得重视的隐匿人群 ,采取早期鉴定、干预与综合     

妊娠中晚期妇女缺铁性贫血预测模型的构建及应用评估

目的 构建妊娠中晚期妇女缺铁性贫血（iron deficiency anemia,IDA）预测模型,并建立个体预测IDA发生风险的列线图模型。方法 选取2018年5月 - 2019年11月在本院妇产科进行产检的431例妊娠中晚期妇女,均进行血常规和血清铁检测,根据有无IDA分为IDA组与非IDA组。对两组各项因素进行比较,采用多因素logistic回归分析妊娠中晚期女性发生IDA的危险因素,并采用R软件建立预测发生的列线图模型,采用ROC曲线分析列线图模型对妊娠中晚期女性发生IDA的预测效率。结果 431例妊娠中晚期女性发生IDA有83例（19.26%）;经单因素分析显示,年龄、月经济收入、孕周、初次月经年龄、孕期含铁食物摄入频次、补充铁剂频次、是否定期复查血常规与妊娠中晚期妇女IDA的发生有关（χ2/P = 5.964/0.015、11.183/0.001、7.336/0.007、7.907/0.005、12.911/0.011、14.202/0.001、4.901/0.027）;logistics回归分析显示,孕周（Waldχ2 = 5.891,P = 0.015,OR = 1.931,95%CI:1.135～3.285）、孕期含铁食物摄入频次少（Waldχ2 = 4.410,P = 0.036,OR = 3.044,95%CI:1.077～8.603）、未定期复查血常规（Waldχ2 = 4.997,P = 0.025,OR = 3.552,95%CI:1.169～10.793）是妊娠中晚期妇女发生IDA的危险因素,月经济收入高（Waldχ2 = 6.285,P = 0.012,OR = 0.334,95%CI:0.141～0.787）、补充铁剂频次多（Waldχ2 = 5.370,P = 0.020,OR = 0.314,95%CI:0.118～0.837）是其保护因素;ROC曲线显示列线图模型预测IDA发生的曲线下面积为0.714,截断点为0.226,预测灵敏度与特异度分别为74.00%、90.00%。结论 月经济收入低、孕周、孕期含铁食物摄入频次少、补充铁剂频次少、未定期复查血常规是妊娠中晚期妇女发生IDA的危险因素,而利用上述因素构建模型可为妊娠中晚期妇女IDA发生风险的预测及防护性措施的制定提供参考依据。