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（nb）、红细胞压积（Hot）、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Hot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。     

不同形式补铁对维持性血液透析患者肾性贫血效果比较

40例维持性血液透析伴肾性贫血患者随机分为两组,两组均给予促红细胞生成素(EPO)治疗,口服组另给予右旋糖酐铁片口服,静脉组给予蔗糖铁注射液 0.9%氯化钠静脉滴注。发现治疗后两组血红蛋白、血球压积、网织红细胞,以及血清转铁蛋白、转铁蛋白饱和度均明显改善,不同时期静脉组优于口服组。可见,静脉补铁效果好于口服。     

蔗糖铁联合促红细胞生成素治疗维持性血液透析肾性贫血的疗效观察

目的观察蔗糖铁联合促红细胞生成素(erythropoietin,EPO)治疗维持性血液透析肾性贫血的临床疗效。方法选择2013年4月—2014年4月收治的血液透析肾性贫血患者186例作为研究对象,随机分为对照组和观察组各93例。对照组给予EPO治疗,观察组在对照组的基础上给予蔗糖铁治疗。对比两组患者临床疗效及红细胞计数(red blood cell count,RBC)、血红蛋白(heamoglobin,Hb)、血清铁蛋白(serum ferritin,SF)、红细胞压积(hematocrit,,HCT)和血清转铁蛋白饱和度(transferrin saturation,TSAT)水平。计量资料组间比较采用t检验,组内比较采用配对t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果观察组有效率为93.54%,显著高于对照组的83.87%,差异有统计学意义(P0.05)。治疗后观察组RBC、Hb、SF、HCT及TSAT分别为(3.89±0.54)×1012/L、(115.74±7.35)g/L、(469.02±45.35)μg/L、(35.33±2.41)%、(30.01±2.52)%;对照组分别为(2.60±0.45)×1012/L、(80.14±6.26)g/L、(332.17±30.52)μg/L、(25.27±2.30)%、(20.02±1.64)%,差异均有统计学意义(均P0.05)。观察组共2例患者发生不良反应,占2.15%,对照组7例,占7.53%,差异有统计学意义(P0.05)。结论蔗糖铁联合EPO治疗维持性血液透析肾性贫血可有效缓解患者两组不良反应发生率比较铁缺乏状况,促进机体对EPO的吸收,且不良反应轻微,值得临床推广应用。     

两种注射方法治疗血液透析患者肾性贫血的疗效观察及护理

目的 观察重组人促红细胞生成素（rhEPO）皮下注射与血透结束时从静脉端管路注射的方法对透析患者贫血的疗效,以减轻皮下注射给患者带来的不必要的痛苦,对患者实施人性化治疗。方法 将40例患者分为两组,每组20例,A组应用rhEPO 皮下注射,B组应用rhEPO血透结束时从静脉端管路注射,两组治疗期间均不再输血,同时静脉补充铁剂。结果与结论 两种注射方法治疗血液透析患者肾性贫血的疗效相同,患者症状改善,生活质量提高。     

静脉用蔗糖铁联合促红细胞生成素治疗肾性贫血患者的疗效观察

目的 比较静脉用蔗糖铁与口服右旋糖酐铁治疗慢性肾衰竭患者肾性贫血的疗效与安全性.方法 将60例肾性贫血患者按照随机数字表法分为两组:静脉组静脉给予蔗糖铁100mg/次,每周2次;口服组给予右旋糖酐铁150 mg/d口服.观察治疗后4、8、12周血红蛋白(Hb)、红细胞压积(Hct)、铁蛋白(SF)和转铁蛋白饱和度(TSAT)等的变化,并观察治疗达标后不良反应发生情况.结果 治疗后静脉组Hb由治疗前(79.87±13.19)g/L上升为(106.11±12.38)g/L,口服组Hb由治疗前(85.41±11.49)g/L上升为(94.68±10.06)g/L,两组治疗前后比较差异均有统计学意义(P<0.01),且静脉组治疗后Hb水平明显高于口服组(P<0.01).静脉组治疗后血清SF、TSAT明显高于口服组(P<0.01).口服组发生不良反应5例(16.7%),静脉组无不良反应发生.结论 静脉用蔗糖铁治疗肾性贫血的疗效及安全性明显优于口服右旋糖酐铁.     

静脉用蔗糖铁联合促红细胞生成素治疗肾性贫血患者的疗效观察

Objective To determine the efficacy and safety of intravenous iron sucrose and oral iron dextran in renal anemia patients. Methods Sixty renal anemia patients were randomized into two groups:intravenous iron group(IV group, 100 mg iron sucrose twice a week) and oral iron group(oral group, 150 mg iron dextran every day). The changes in hemoglobin (Hb),hematocrit (Hct),serum ferritin (SF),and transferrin saturation (TSAT) were assessed on week 4,8, and 12 after treatment. The maintenance dosages of erythropoietin (EPO) after reaching treatment target and the adverse events were also observed. Results Hb increased after treatment in IV group [(79.87 ± 13.19) g/L to (106.11 ± 12.38) g/L] and oral group [(85.41 ± 11.49) g/L to (94.68 ± 10.06) g/L],and compared with that before treatment, there was significant difference in each group(P< 0.01 ). Also significant difference showed in Hb levels after treatment between two groups(P< 0.01 ). SF and TSAT levels were higher after treatment in IV group than those in oral group (P < 0.01 ). The adverse event was lower in IV group (0) than that in oral group (16.7%,5/30).Conclusions Oral iron dextran which has more adverse events and poor efficacy in curing anemia, can not correct anemia ideally. Meanwhile intravenous iron sucrose has positive effects on renal anemia with low adverse events, and it can be used as a long term iron supplementation in hemodialysis patients.     

静脉用蔗糖铁联合促红细胞生成素治疗肾性贫血患者的疗效观察

Objective To determine the efficacy and safety of intravenous iron sucrose and oral iron dextran in renal anemia patients. Methods Sixty renal anemia patients were randomized into two groups:intravenous iron group(IV group, 100 mg iron sucrose twice a week) and oral iron group(oral group, 150 mg iron dextran every day). The changes in hemoglobin (Hb),hematocrit (Hct),serum ferritin (SF),and transferrin saturation (TSAT) were assessed on week 4,8, and 12 after treatment. The maintenance dosages of erythropoietin (EPO) after reaching treatment target and the adverse events were also observed. Results Hb increased after treatment in IV group [(79.87 ± 13.19) g/L to (106.11 ± 12.38) g/L] and oral group [(85.41 ± 11.49) g/L to (94.68 ± 10.06) g/L],and compared with that before treatment, there was significant difference in each group(P< 0.01 ). Also significant difference showed in Hb levels after treatment between two groups(P< 0.01 ). SF and TSAT levels were higher after treatment in IV group than those in oral group (P < 0.01 ). The adverse event was lower in IV group (0) than that in oral group (16.7%,5/30).Conclusions Oral iron dextran which has more adverse events and poor efficacy in curing anemia, can not correct anemia ideally. Meanwhile intravenous iron sucrose has positive effects on renal anemia with low adverse events, and it can be used as a long term iron supplementation in hemodialysis patients.     

蔗糖铁治疗肾性贫血的疗效分析

肾性贫血是慢性肾脏病终末期最常见的临床并发症,也是影响透析病人生存质量的独立危险因素。自从促红细胞生成素(EPO)应用于临床以来,肾性贫血的治疗已经取得突破性进展。但实际临床治疗过程中很多因素都会影响到EPO的效果,其中最常见原因就是铁缺乏。但实际过程中大部分患者由于口服补铁剂效果不佳或不良反应明显,不能坚持长期治疗,本研究通过对两种补     

静脉与口服补铁对血透患者贫血和心功能影响临床观察

肾性贫血是慢性肾衰患者最常见的并发症,应用促红细胞生成素（EPO）治疗肾性贫血的同时,补充铁剂以纠正绝对性或相对性铁缺乏已得到广泛认同。为此,我们比较了静脉补铁（蔗糖铁）与口服补铁（琥珀酸亚铁）在短期内（10周）对肾性贫血患者贫血的纠正以及心功能相关情况,     

国产与进口促红素治疗肾性贫血60例疗效比较

目的：观察国产促红素（益比奥）治疗肾性贫血的疗效,并与进口促红素（利血宝）进行比较。方法：60例肾性贫血病人随机分为治疗组（30例）,治疗组用益比奥,对照组用利血宝,观察两组病人治疗前后RBC,Hb,Hct（红细胞压积）,Ret（网状细胞）的变化。结果：治疗后两组病人的RBC、Hb、Hct,Ret均明显升高,且不良反应轻微。结论：国产与进口促红素同样疗效显著,不良反应少。     

Reducing iron deficiency anemia in Bolivian school children: Calcium and iron combined versus iron supplementation alone

ObjectiveThe aim of this study was to determine the effect of combined calcium and iron versus single iron supplementation on iron status in Bolivian schoolchildren.MethodsChildren ages 6 to 10 y old (N = 195), were randomly assigned to receive either 700 mg Ca (as calcium carbonate) plus 30 mg Fe (as ferrous sulfate) (Ca + Fe group) or 30 mg Fe (as ferrous sulfate) (Fe group). The doses were administered daily, from Monday to Friday, between meals at school over 3 mo. Iron status was assessed at baseline and after intervention. Additionally, overall nutritional status was assessed by anthropometry and an estimation of dietary intake.ResultsAt baseline, the prevalence of anemia in the Ca + Fe group and the Fe group were 15% and 21.5%, respectively. After 3 mo follow-up, the prevalence of iron deficiency anemia dropped significantly (P < 0.001) to 3% in both groups (χ² = NS). Iron dietary intake was within recommended levels, but calcium intake only covered 39% of the Recommended Daily Intake.ConclusionCombined calcium and iron supplementation is equally as effective as single iron supplementation in reducing the prevalence of iron deficiency anemia in Bolivian school children.     

蔗糖铁注射液治疗老年缺铁性贫血疗效观察

目的 观察蔗糖铁注射液治疗老年缺铁性贫血(IDA)的疗效和不良反应.方法 选择32例老年IDA患者,按随机数字表法分为静脉组(17例)和口服组(15例),观察两种方法对改善贫血的疗效和不良反应.结果 治疗后静脉组及口服组血红蛋白(Hb)均较治疗前升高,分别为(100.18±8.71)g/L和(85.80±6.92)g/L,两组比较差异有统计学意义(P＜0.01);治疗后血清铁亦有上升,两组分别为(23.84±5.34.)μmol/L和(14.63±3.29)μmol/L,与治疗前比较差异有统计学意义(P＜0.01).静脉组无明显不良反应发生,口服组有6例(40%)发生胃肠道反应.结论 静脉用蔗糖铁可作为老年IDA患者补铁方式,疗效优于口服铁剂,且不良反应发生率低.

Abstract：

Objective To observe the effect and adverse reactions of iron sucrose injection in treating old patients with iron deficiency anemia(IDA). Methods Thirty-two old patients with IDA were divided into injection group(17 patients)and oral group(15 patients)by random digits table. The effects of improvement on IDA and their adverse reactions were observed. Results After treatment, hemoglobin(Hb)in the injection group and oral group was(100.18±8.71)g/L and(85.80 ± 6.92)g/L(P＜0.01), and serum iron was(23.84±5.34)μmol/L and(14.63±3.29)μmol/L(P＜0.01).There were no obvious adverse reactions in injection group, whereas there were 6 cases(40%)with gastric and colon adverse reaction in oral group. Conclusions The treatment of intravenous injection of iron sucrose can be effectively used to cure old patients with IDA. It has better effect and has lower rate of adverse reaction.     

慢性肾脏病不同分期患者贫血与铁代谢的关系

目的探讨不同分期慢性肾脏病（CKD）患者贫血与铁代谢指标的相关关系。方法选择2012年10月至2013年6月在广西医科大学第一附属医院就诊的CKD患者132例作为研究对象,根据。肾小球滤过率（eGFR）分为CKD1～5期,测定其贫血指标、铁代谢指标、红细胞参数。应用logistic多因素回归分析不同分期CKD患者贫血的相关危险因素。结果CKD1～5期血红蛋白（Hb）、红细胞压积（Hct）水平下降,CKD3期、CKD4期、CKD5期均与其余各期差异均有统计学意义（P〈0．05）。经logistic多因素分析,年龄（OR=0．968,95％Ch0．943～0．994）、收缩压（OR=0．976,95％CI：0、955～0．996）、血清铁（OR=1．229,95％CI：1．111-1．360）、总铁结合力（OR=1．071,95％CI：1．023～1．121）是CKD1～5期患者贫血的独立影响因素;性别（OR=0．096,95％CI：0．020～0．458）、总铁结合力（OR=I．080,95％CI：1．013—1．152）是CKD1～2期患者贫血的独立影响因素;年龄（OR=0．736,95％CI：0．712～0．761）、收缩压（OR=0．812,95％CI：0．793～0．826）、血清铁（OR=1．204,95％CI：1．034～1．402）、总铁结合力（OR=1．630,95％CI：1．545-1．726）是CKD3-5期患者贫血的独立影响因素。缺铁组较非缺铁组平均红细胞体积（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）低,差异均有统计学意义（P〈0．05）。结论CKD各期患者普遍存在贫血和铁缺乏,CKD患者贫血与铁代谢密切相关。     

Iron deficiency anemia: Pregnancy outcomes with or without iron supplementation

Objective

To estimate the efficacy of iron supplementation in anemic pregnant women on the basis of occurrence of pregnancy complications and birth outcomes.

Methods

Comparison of the occurrence of medically recorded pregnancy complications and birth outcomes in pregnant women affected with medically recorded iron deficiency anemia and iron supplementation who had malformed fetuses/newborns (cases) and who delivered healthy babies (controls) in the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities.

Results

Of 22 843 cases with congenital abnormalities, 3242 (14.2%), while of 38 151 controls, 6358 (16.7%) had mothers with anemia. There was no higher rate of preterm births and low birth weight in the newborns of anemic pregnant women supplemented by iron. However, anemic pregnant women without iron treatment had a significantly shorter gestational age at delivery with a somewhat higher rate of preterm births but these adverse birth outcomes were prevented with iron supplementation. The rate of total and some congenital abnormalities was lower than expected and explained mainly by the healthier lifestyle and folic acid supplements. The secondary findings of the study showed a higher risk of constipation-related hemorrhoids and hypotension in anemic pregnant women with iron supplementation.

Conclusion

A higher rate of preterm birth was found in anemic pregnant women without iron treatment but this adverse birth outcome was prevented with iron supplementation. There was no higher rate of congenital abnormalities in the offspring of anemic pregnant women supplemented with iron and/or folic acid supplements.     

铁调素与早产儿缺铁性贫血的研究现状

缺铁性贫血(IDA)是早产儿生后面临的最主要挑战之一.IDA严重影响早产儿的体格生长、免疫功能及神经系统发育.目前,尚无早期诊断早产儿IDA的特异性指标,并且对于早产儿IDA亦缺乏统一诊断和治疗标准.对于铁调素测定,可以早期特异性反映早产儿体内铁状态变化,并且可用于早期诊断早产儿IDA,而且敏感度及特异度均较高,还可为...     

补充维生素A与铁对改善学龄前儿童贫血和免疫功能的影响

目的为观察学龄前儿童亚临床维生素A(VA)缺乏状态缺铁时,机体免疫功能的变化以及VA与铁同时补充对改善儿童铁营养状况和免疫功能的影响.方法检测北京农村270名3～7岁儿童血清VA含量和血红蛋白(Hb)、血清铁(SI)、运铁蛋白饱和度(TS)及血清铁蛋白(SF)后,将其分为正常、低 VA、低铁和低VA低铁4组,每组选40人,检测血清免疫球蛋白IgA、IgG、IgM 与白细胞介素-2(IL-2).然后将低VA低铁组儿童随机分为补铁组 (每日口服相当于30 mg元素铁的硫酸亚铁,连续8周)和补VA+铁组(口服VA胶丸12 500 IU /次,2次/周,连续8周;口服铁量同补铁组,连续8周),分别进行干预.干预后重复检测血清VA、血液铁生化指标和以上免疫指标,进行两组间比较,并与干预前比较. 结果低VA低铁组儿童血清IgM为(1 260±310) mg/L显著高于正常组的(1 0 7 0±170) mg/L.对其实施VA+铁联合干预后,血清TS为(26.5±8.6)%,明显高于补铁前的(16.2±1.6)%和单纯补铁组的(22.3±3.8)%;IL-2在VA与铁同时补充后为(2 78.9±117.7) ng/L,显著高于补充前的(161.6±90.3) ng/L和单纯补铁组的(189 .5 ±89.3)ng/L的水平;其他铁生化指标和免疫指标无明显变化.结论对存在亚临床VA缺乏状态的缺铁儿童实施一定剂量的VA+铁联合干预,对改善机体铁营养状况和免疫功能有明显作用.     

婴幼儿缺铁性贫血对认知功能的影响及干预研究

目的 通过总结婴幼儿缺铁性贫血对认知功能产生近期和远期影响以及影响机制和干预措施,发现贫血影响婴幼儿的关键期,为提出更高效的干预措施提供科学依据。方法 使用“anemia”、“infants”、“iron deficiency”、“cognition”和“贫血”、“铁缺乏”以及“认知功能”等为关键词,通过PubMed和中国知网（CNKI）进行文献检索,共收集38篇相关文献,用描述性研究对婴幼儿缺铁性贫血对认知功能的影响及干预措施进行综述。结果 婴幼儿缺铁性贫血对认知功能的影响具有持续性及不可逆性以及对认知功能影响存在关键期,目前对婴幼儿缺铁性贫血的干预措施。结论 孕期补铁、延迟期待结扎以及婴幼儿补铁可以改善缺铁性贫血对认知功能的影响。     

血管紧张素转换酶抑制剂对血液透析患者贫血和促红细胞生成素用量的影响

目的 观察血管紧张素转换酶抑制剂(ACEI)对维持性血液透析患者贫血和促红细胞生成素(EPO)用量的影响.方法 90例维持性血液透析合并高血压和贫血的患者,按随机数字表法分为观察组和对照组,每组45例,观察组使用ACEI降血压治疗,对照组使用钙离子拮抗剂(CCB)降血压治疗.比较两组患者在0、2、4、6、8、10、12个月时的血红蛋白、EPO用量、血清EPO.结果 观察组的血红蛋白逐渐下降,6个月及之后与对照组比较差异有统计学意义[6个月:(94.21±9.20)g/L比(105.55±9.16)g/L;12个月:(95.90±6.75)g/L比(105.81±4.45)g/L;P<0.05];观察组EPO用量逐渐上升,8个月及之后与对照组比较差异有统计学意义[8个月:(10090.75±1918.35)U/周比(7010.32±1600.15)U/周;12个月:(11 586.39±2009.76)U/周比(7068.48±1615.35)U/周,P<0.05].在整个研究期间,两组患者的血清EPO水平均保持稳定不变.结论 ACEI治疗会加重维持性血液透析患者的贫血和降低EPO的疗效.

Abstract：

Objective To observe the effect of angiotensin-converting enzyme inhibitors (ACEI) on anemia and erythropoietin (EPO) requirements in maintenance hemodialysis patients. Methods Ninety maintenance hemodialysis patients with hypertension and anemia were divided into 2 groups by random digits table, observation group (45 cases, using ACEI as antihypertensive treatment), control group [45 cases,using calcium channel blocker (CCB) as antihypertensive treatment]. The follow-up period after starting ACEI or CCB therapy was one year. The hemoglobin concentration, serum EPO, EPO requirements were compared after 0, 2, 4, 6, 8, 10, 12 months' treatment. Results In response to ACEI, the mean hemoglobin value in observation group decreased progressively, reaching statistical significance after 6 months, and it had significant difference compared with that in control group [6 months: (94.21±9.20) g/Lvs. (105.55±9.16) g/L,12 months: (95.90±6.75) g/L vs. (105.81±4.45) g/L,P <0.05]. The EPO requirements experienced a progressive increase in observation group and reached statistical significance after 8 months, compared with those in control group [8 months: ( 10 090.75±1918.35) U/week vs. (7010.32±1600.15) U/week, 12 months: (11 586.39±2009.76) U/week vs. (7068.48±1615.35) U/week,P<0.05].Serum erythropoietin concentration remained stable during the study in two groups. Conclusion ACEI can worsen anemia and reduce the efficacy of EPO in maintenance hemodialysis patients.