尿毒症患者口服与静脉补铁疗效对比分析

目的：比较慢性肾功能衰竭（CRF）维持性血液透析伴肾性贫血患者，口服多糖铁复合物与静脉注射右旋糖酐氢氧化铁对改善贫血的疗效及副作用。方法：100例患者随机分为口服组与静脉组，每组50例，皮下注射促红细胞生成素（EPO）100-150单位／kg／周，口服组予力蜚能150mg／d，连续8周;静脉组静脉注射科莫非100-200mg至完成所需剂量。结果：静脉及口服补铁均可使血红蛋白、红细胞压积、血清铁蛋白和转铁饱和度升高，静脉组治疗前后差异有显著性（P〈0．01），口服组Hb、HCT无显著性差异（P〉0．05），SF和TSAT有显著性差异（P〈0．01），两组比较治疗前后差值有显著性差异（P〈0．01）。结论：纠正肾性贫血，在使用EPO的同时，静脉补铁优于口服铁剂。     

蔗糖铁联合大剂量EPO治疗血透患者肾性贫血的疗效

目的比较静脉注射蔗糖铁与口服硫酸亚铁补铁联合大剂量EPO治疗维持性血液透析患者肾性贫血的疗效及安全性。方法将80例维持性血液透析患者随机分为试验组和对照组,每组各40例。试验组将蔗糖铁100 mg加入100 ml生理盐水中,于血透结束前5 min从血透静脉端注入血液中,2次/w,血透2～4次/w;对照组采用口服硫酸亚铁缓释片0.45 g,2次/d。两组患者均同时给予静脉注射重组人红细胞生成素1万U,2次/w。观察两组患者治疗前、治疗后不同时间血红蛋白水平、肾功能指标及不良反应。结果两组患者的血红蛋白水平在治疗4、8 w后,均较治疗前显著升高（P〈0.05或P〈0.01）,血球压积也较治疗前明显升高（P〈0.05或P〈0.01）,但试验组的血红蛋白及血球压积较对照组升高更显著（P〈0.05）。两组患者的肾功能指标及不良反应均无明显差异。结论在使用大剂量EPO治疗贫血过程中,注射用蔗糖铁是治疗维持性血液透析患者肾性贫血的有效补铁药物。     

血液透析充分性对药物治疗肾性贫血的意义

目的：观察血液透析充分性对药物治疗肾性贫血的意义。方法：随机对终末期肾脏病（ESRD）合并肾性贫血患者30例分两组行血液透析（HD）2次及血液透析（HD）3次,在药物治疗肾性贫血不变基础上,12周后并据血红蛋白（Hb）、红细胞压积（Hct）进行评价。结果：采用HD3次治疗患者肾性贫血纠正高于HD2次患者,P〈0.05有统计学意义。结论：充分血液透析对药物治疗肾性贫血有明显影响。     

右旋糖酐氢氧化铁治疗尿毒症血透患者贫血疗效观察

肾性贫血对尿毒症患者的长期生存有着很大的影响，静脉铁在中国上市以前对于口服铁剂吸收不良，贫血难以纠正的患者无更好的应对方法。2002—01～2007—05我们对51例尿毒症长期维持性血透铁缺乏，口服铁治疗效果不佳的患者静脉使用低分子右旋糖酐氢氧化铁（科莫非）进行了疗效和安全性观察。报告如下。     

丹参酮ⅡA对糖尿病维持性血透伴缺血性心脏病患者的疗效观察

目的探讨丹参酮ⅡA磺酸钠对糖尿病维持性血液透析（MHD）伴缺血性心脏病（IHD）患者的疗效。方法将40例MHD伴IHD患者随机分成2组。治疗组20例,给予生理盐水250 ml＋丹参酮ⅡA磺酸钠注射液20 mg,3次/w,于每次透析结束后静脉输入;对照组给予口服复方丹参滴丸10粒/次,3/d。两组疗程均为6个月。分别记录两组患者治疗前后的血脂、血液流变学、超氧化物歧化酶（SOD）、丙二醛（MDA）、心肌耗氧量、纤维蛋白原（FIB）、心电图及有无心绞痛症状。结果与对照组治疗后相比,治疗组治疗后心肌耗氧量、MDA、FIB、全血黏度高切和低切、血浆黏度、红细胞聚集指数显著下降（P〈0.05或P〈0.01）,心电图ST段、SOD显著升高（P〈0.05）。结论丹参酮ⅡA磺酸钠降低血液黏度,改善心肌缺氧,明显减轻维持性血液透析患者的心肌缺血。     

加巴喷丁与血液透析滤过改善皮肤瘙痒疗效比较观察

目的：观察比较加巴喷丁与血液透析滤过改善维持性血液透析患者皮肤瘙痒的疗效。方法：选择维持性血液透析致顽固皮肤瘙痒42例,随机分为加巴喷丁组和血液透析滤过组各21例。两组均接受慢性肾脏病一体化治疗,血液透析滤过组每周常规血液透析2次,血液透析滤过1次;加巴喷丁组于透析日睡前口服加巴喷丁0．2g,3次／周。比较两组患者皮肤瘙痒改善情况及睡眠质量;治疗过程中,每月1次常规检测血红蛋白、血清钙、血清磷、血肌酐、血尿素氮及全段甲状旁腺激素等,并观察不良反应发生情况。结果：治疗后,加巴喷丁组缓解瘙痒总有效率85．7％,显著高于血液透析滤过组的52．4G（P〈0．05）。两组皮肤瘙痒、睡眠质量分值均较治疗前显著降低,但加巴喷丁组皮肤瘙痒分值、睡眠质量分值显著低于血液透析滤过组治疗后（P〈0．05）。两组血肌酐、血尿素氮、血钙、血红蛋白水平差异不显著（P〉0．05）,血液透析滤过组血磷、iPTH水平显著低于加巴喷丁组（P〈0．05）。结论：口服加巴喷丁和血液透析滤过均可减轻瘙痒症状、改善患者睡眠质量,加巴喷丁改善瘙痒及睡眠的效果优于血液透析滤过,但血液透析滤过对调整钙、磷代谢紊乱的效果优于加巴喷丁。     

阿发骨化醇治疗血透患者肾性骨病40例疗效分析

目的 观察阿发骨化醇治疗维持性血透患者肾性骨病的效果.方法 选择我院并发肾性骨病的血透患者40例,均为慢性肾功能不全（尿毒症期）患者,并在我院行维持性血液透析治疗,2~3次/w,3.5~4 h/次,随机分为治疗组20例,1次/d,对照组20例.两组均行常规维持性血液透析治疗,同时积极治疗原发病及其他并发症,对照组口服醋酸钙胶囊0.6 g,1次/d,治疗组则在醋酸钙治疗的同时加用阿法骨化醇片0.5 μg,口服1次/d,治疗3个月后,观察两组透析前后的血钙、血磷、肌酐、尿素氮等生化指标变化及骨痛缓解的总有效率.结果 治疗3个月后,治疗组血钙升高到正常水平,显著高于治疗前（P＜0.01）,血磷显著下降（P＜0.01）;而对照组的血钙虽然有所上升,血磷有所下降,但与治疗前相比无显著差异（P＞0.05）,且与治疗组治疗后有显著差异（P＜0.05）;治疗组的骨痛总缓解率为93%,而对照组为36%,治疗组显著高于对照组（P＜0.01）.结论 阿发骨化醇治疗维持性血透患者的肾性骨病具有疗效好、副作用少等优点,值得临床上广泛使用.     

肾性贫血治疗中静脉铁剂的合理应用

肾性贫血的治疗,不仅需要合理应用促红细胞生成素(EPO),还需要及时有效地补充铁剂,否则,即使长期大剂量使用EPO,贫血也难以纠正.据统计,在美国接受EPO治疗的终末期慢性肾衰患者中,50%以上存在缺铁[1].对于如何应用EPO,临床上已积累了较为丰富的经验[2],但对于如何补充铁剂临床上还认识不足.由于口服补铁尚未证实有效,静脉补铁近年受到人们愈来愈多的关注,并且临床也证实有效[3,4].本文从临床实用角度,介绍肾性贫血治疗中静脉铁剂的合理应用.     

左卡尼汀联合促红细胞生成素对肾性贫血的疗效观察

目的:通过观察左卡尼汀联合促红细胞生成素对尿毒症维持性血液透析患者肾性贫血的疗效,探讨左卡尼汀在肾性贫血中的治疗价值。方法:将维持性血液透析患者60例随机分成两组,两组均于血液透析后皮下注射促红细胞生成素(EPO),治疗组每次加用左卡尼汀1.0 g静脉注射,连续治疗12周。治疗前后比较血红蛋白(Hb)、红细胞比容(Hct)并评价。结果:两组治疗前后的Hb、Hct均有升高,而治疗组较对照组升高差异具有统计学意义(P<0.05)。而血压、心率、肾功能等指标在治疗前后无明显变化。结论:左卡尼汀联合促红细胞生成素对肾性贫血治疗效果好,优于单用促红细胞生成素纠正贫血。     

蔗糖铁注射液治疗血液透析后贫血20例

慢性肾衰患者并发严重的肾性贫血,其主要原因之一为促红细胞生成素缺乏^[1]。自从重组人促红细胞生成素（rHuEPO）用于临床以来,使肾性贫血的治疗取得了突破性进展．极大地改善了肾衰患者的状况;而铁也是血红蛋白生成所必需的,补充铁剂对rHuEPO疗效至关重要。笔者总结分析了静脉用蔗糖铁与口服琥珀酸亚铁治疗尿毒症血液透析患者贫血的临床疗效。     

Effects of training and iron supplementation on iron status of cross-country skiers

We have studied the effects of iron treatment on iron deficient cross-country skiers. Kind and duration of their daily training were also considered. Forty-eight athletes were divided in three balanced groups: Group A received 160 mg ferritinic iron/die, Group B received the same amount of iron and 1 gr of ascorbic acid and Group C was untreated. Blood samples were taken at the start, after two months and four months of supplementation. Hematological and iron status parameters were determined. Average training duration was 80 min a day. Running was the most frequent method of training but also roll and country skiing were commonly used. At the initial sample low serum ferritin values were found in all the three groups (Group A = 23.3 micrograms/l, Group B = 20.9 micrograms/l and Group C = 23.5 micrograms/l). After iron treatment serum ferritin increased in Groups A and B (+67.8% and +63.6% respectively) but was slightly reduced in Group C. Serum iron was unchanged and total iron binding capacity decreased following ferritin increase. Ascorbic acid failed to increase iron absorption in Group B. A significant reduction of haptoglobin (-14% and -9% in Group A and B respectively) was also documented. We conclude that cross-country skiers extensively use running in their training and it may be one of the cause of their poor iron status. Ferritinic iron treatment seems to be effective in replacing iron stores in cross-country skiers who underwent heavy training.     

Silicon instead of iron

The effects of light weapons are now regularly seen on television and are becoming an international issue, particularly regarding their impact on civilians. It is claimed that 80% or more of deaths and injuries in today's wars are civilian; there is no objective evidence for this as little accurate information is available. Recent surveys suggest, however, a proportion of between 35 and 65% ‐ still far too high considering the protection to which civilians are entitled under international humanitarian law. It is proposed the problem arises from twentieth‐century killing power in the hands of individuals with fifteenth‐century discipline and organization.

Recent systematic surveys distinguish between civilian deaths from light weapons in combat and non‐combat situations. A high proportion of combat deaths is due to fragmenting weapons such as mortars targeted on populated areas. Many weapon‐related deaths in non‐combat situations are accidental (cleaning weapons, handling by children during play) and others are related to domestic disputes. The availability and use of weapons also affects civilians indirectly in many ways, such as ill‐health in refugees, psychosocial effects on women and children, and economic and environmental consequences.

A variety of schemes exist to reduce the availability of light weapons and reintegrate their users into society. The international community must extend and make better use of these measures.     

MRI of brain iron

A prominently decreased signal intensity in the globus pallidum, reticular substantia nigra, red nucleus, and dentate nucleus was routinely noted in 150 consecutive individuals on T2-weighted images (SE 2000/100) using a high field strength (1.5 T)MR system. This MR finding correlated closely with the decreased estimated T2 relaxation times and the sites of preferential accumulation of ferric iron using the Perls staining method on normal postmortem brains. The decreased signal intensity on T2-weighted images thus provides an accurate in vivo map of the normal distribution of brain iron. Perls stain and MR studies in normal brain also confirm an intermediate level of iron distribution in the striatum, and still lower levels in the cerebral gray and white matter. In the white matter, iron concentration is (a) absent in the most posterior portion of the internal capsule and optic radiations, (b) higher in the frontal than occipital regions, and (c) prominent in the subcortical "U" fibers, particularly in the temporal lobe. There is no iron in the brain at birth; it increases progressively with aging. Knowledge of the distribution of brain iron should assist in elucidating normal anatomic structures and in understanding neurodegenerative, demyelinating, and cerebrovascular disorders.     

Influence of dietary iron source on measures of iron status among female runners

The purpose of the present investigation was to determine whether female runners who consume a modified vegetarian diet are predisposed to iron deficiency. Two groups of female runners who were matched for age, weight, aerobic capacity, miles run per week, and number of pregnancies were obtained for this study. One group (N = 9) regularly consumed a modified vegetarian diet (MV, less than 100 g red meat.wk-1), while the other group (N = 9) consumed a diet which included red meat (RM). Serum ferritin values were significantly (P less than 0.05) lower for the MV group (X +/- SE, 7.4 +/- 1.4 ng.100 ml-1) than for the RM group (19.8 +/- 4.2 ng.100 ml-1). Total iron binding capacity (TIBC) of the serum was also significantly different between the two groups of subjects (MV, 366.5 +/- 12.2 micrograms.100 ml-1; RM, 327.2 +/- 9.6 micrograms.100 ml-1). While dietary iron intake was comparable for the two groups (MV, 14.7 +/- 2.0 mg.d-1; RM, 14.0 +/- 2.2 mg.d-1, the bioavailability of the dietary iron was significantly different (MV, 0.66 +/- 0.08 mg.d-1; RM, 0.91 +/- 0.10 mg.d-1). As the presence of heme iron (from meat, fish, and poultry) increases the bioavailability of dietary iron, the results of the present investigation suggest that vegetarian athletes have altered iron status due to the form in which their dietary iron is consumed.     

MRI of cardiac iron overload

Transfusion therapy has greatly improved the survival of transfusion dependent thalassemia major (TM) patients; however, the resultant iron load damages tissues including the heart, liver and endocrine organs. Among these, heart complication still remains the leading cause of mortality. Myocardial iron deposition can occur independently of other solid organ involvement; conversely, the heart may be spared despite heavy siderosis in other tissues. Iron chelation treatment diminishes the risk of hemosiderosis; however, the chelation treatment has its own toxicities and might not be available to all patients due to costs. Close monitoring of individual organ iron concentration and function is thus important for optimization of individual patient care. This review outlines the importance and clinical significance of recently available MRI techniques for monitoring cardiac iron load. J. Magn. Reson. Imaging 2012;36:1052–1059. © 2012 Wiley Periodicals Inc.     

Extractable iron in experimental hematomas

Summary The extractable iron and total iron were determined in experimental, subcutaneous hematomas (5 ml blood) of rats after different periods of vital time. The extractable iron was determined from homogenate extract obtained after 24-h incubation with concentrated HCl diluted 1:3 and protein precipitation. For the determination of total iron, the specimens were wet-ashed. The same iron determinations were also made for the corresponding control specimens of the subcutaneous tissue. Extractable iron started to rise over the control values in 2-day-old hematomas, being about 5 times higher after 3 days, about 15 times higher after 7 days, and about 20 times higher after 14 days. The ratio of extractable iron and total iron expressed as percentages was about 1% in 1-h and in 1-day-old hematomas, about 20% in 3-day-old hematomas, about 50% in 7-day-old hematomas, and about 65% in 14-day-old or older hematomas. The effect of autolysis for 3 days at room temperature was studied on 1-h-old hematomas. Extractable iron values were slightly higher in the autolyzed specimens, but the difference was statistically insignificant as compared to specimens taken immediately after death.     

Superparamegnetic iron oxides for MRI

Pharmaceutical iron oxide preparations have been used as MRI contrast agents for a variety of purposes. These agents predominantly decrease T2 relaxation times and therefore cause a decrease in signal intensity of tissues that contain the agent. After intravenous adminstration, dextran-coated iron oxides typically accumulate in phagocytic cells in liver and spleen. Clinical trials have shown that iron oxide increases lesion/liver and lesion/spleen contrast, that more lesions can be depicted than on plain MRI or CT, and that the size threshold for lesion detection decreases. Decreased uptake of iron oxides in liver has been observed in hepatitis and cirrhosis, potentially allowing the assessment of organ function. More recently a variety of novel, target-specific monocrydtalline iron oxides compounds have been used for receptor and immunospecific images. Future development of targeted MRI contrast agents is critical for organ- or tissue-specific quantitative and functional MRI. Correspondence to: R. Weissleder