静脉用蔗糖铁治疗血液透析患者肾性贫血的临床观察

目的比较静脉用蔗糖铁联合促红细胞生成素（EPO）（简称静脉组）与口服右旋糖酐铁片（简称口服组）联合EPO治疗维持性血液透析（MHD）患者。肾性贫血的有效性、安全性。方法38例患者随机分为静脉组和口服组,每组19例,观察8周。结果治疗后患者的贫血均有改善,但静脉组的血红蛋白（Hb）、红细胞压积（HCT）、血清铁蛋白（SF）、血清转铁蛋白饱和度（TSAT）升高幅度和升高速度显著于口服组,差异有统计学意义。静脉组无明显不良反应,口服组6例（31．6％）出现消化道反应。结论蔗糖铁治疗MHD患者肾性贫血安全有效。     

Effect of intravenous iron supplementation on hepatic cytochrome P450 3A4 activity in hemodialysis patients: a prospective, open-label study

BACKGROUND: Cytochrome P450 (CYP) 3A4 is an enzyme with activity dependent on the reduction of heme iron that is responsible for the metabolism of many drugs. CYP3A4 activity is reduced in hemodialysis (HD) patients and thus may be related to functional iron deficiency. OBJECTIVE: The purpose of this study was to investigate the effect of IV iron supplementation on hepatic is CYP3A4 activity in HD patients. METHODS: This prospective, open-label study was conducted in 12 iron-deficient (transferrin saturation <20% or ferritin <100 ng/L) HD patients on stable medication regimens. To probe for hepatic CYP3A4 activity, an erythromycin breath test (ERMBT) was administered before and after 1 g IV iron sucrose (administered as a 100-mg dose [20 mg/mL]), at each of 10 consecutive HD sessions). CYP3A4 activity was estimated by the percentage of administered (14)C exhaled in a single-breath collection after the test dose of erythromycin underwent demethylation by CYP3A4. The ERMBT was also administered to 7 age-, sex-, and race-matched healthy controls. RESULTS: Twelve HD patients (6 Hispanic, 3 white, 3 Native American; 8 men, 4 women; mean [SEM] age, 56.2 [5.0] years; mean [SEM] weight, 77.0 [5.6] kg; and 7 controls (4 men, 3 women; mean [SEM] age, 51.3 [5.0] years; mean [SEM] weight, 77.5 [7.4] kg) were enrolled in the study. In the total HD population studied, mean (SEM) CYP3A4 activity did not change significantly after IV iron replacement (1.46 [0.27] vs 1.57 [0.24] (14)C exhaled/h). A subgroup of 7 HD patients had significantly lower CYP3A4 activity before IV iron replacement compared with the other 5 HD patients and controls (mean [SEM] 0.86 [0.24] vs 2.30 [0.26] and 2.10 [0.26] (14)C exhaled/h; P < 0.01). After IV iron replacement, mean (SEM) CYP3A4 activity increased in these 7 HD patients (120.1% [67.1%]); P = 0.04) and it was not statistically different from that of controls (1.50 [0.36] vs 2.10 [0.26]). CONCLUSIONS: Overall, IV iron administration had no significant effect on hepatic CYP3A4 activity. However, in a subset of HD patients with low baseline CYP3A4 activity indicated by low ERMBT values, IV iron supplementation was associated with a potentially clinically relevant increase in hepatic CYP3A4 activity. Further studies are needed to clarify mechanisms and clinical implications of this interaction.     

静脉补铁在血液透析过程中的应用及护理

目的观察慢性血液透析过程患者静脉补铁改善贫血的效果及总结护理要点。方法109例患者共使用铁剂2398次,停药2w后抽血检查静脉补铁前后血红蛋白、红细胞压积、血清铁蛋白和转铁蛋白饱和度及促红细胞生成素使用剂量。结果1例患者首次使用右旋糖酐铁出现胸闷、心悸,立即停止使用并给予吸氧后缓解。治疗后患者平均血红蛋白升高幅度为21～52g/L,血红蛋白水平均达到目标值水平,红细胞压积升高幅度为4.5%～18.0%,血清铁蛋白升高幅度为230～342μg/mL,转铁蛋白饱和度均达到目标值水平（〉20%）,促红细胞生成素使用剂量为（112.4±20.8）U/kg/w,平均使用剂量下降11.1%。结论在血液透析过程中,静脉补充铁剂能有效改善患者的贫血状况,而且具有安全、快速、高效、方便的优点。同时良好的护理可避免血液透析患者静脉补铁时的不良反应,使治疗顺利进行,并提高患者生活质量。     

Serum non-transferrin bound iron in hemodialysis patients not receiving intravenous iron

BACKGROUND: Non-transferrin bound iron (NTBI) has been found to be raised in end stage renal disease (ESRD) patients on hemodialysis (HD) receiving intravenous (IV) iron. Such NTBI is proposed to cause oxidative damage to biomolecules. METHOD: NTBI, both ferrous (Fe(+2)) and ferric (Fe(+3)) forms, serum ferritin, protein thiols and lipid hydroperoxides were estimated by spectrophotometric and electrochemiluminescence immunoassay methods in patients with chronic renal failure (CRF), patients with ESRD on HD not receiving IV iron, and in normal controls. RESULTS: NTBI (Fe(+2)) in HD patients not receiving IV iron was higher than in normal controls. NTBI (Fe(+3)) was significantly higher in HD patients not on IV iron therapy than in CRF and normal controls. There was no significant increase in NTBI in CRF patients when compared to normal controls. Serum ferritin was higher in HD patients compared to CRF and normal controls. There was a significant increase in lipid hydroperoxides and protein thiols in HD patients and CRF patients when compared to normal controls. The NTBI did not correlate with serum ferritin and oxidative markers. CONCLUSION: The source of NTBI in hemodialysis is not only IV iron therapy but also the hemodialysis procedure per se. It may be due to microhemolysis during hemodialysis. The NTBI is however found to be catalytically inactive.     

静脉补铁对维持性血液透析患者的贫血及微炎症状态的影响

目的：探讨静脉补铁对维持性血液透析患者的贫血及微炎症状态的影响。方法：选择血液透析患者90例，随机分为静脉组（30例）、口服组（30例）和未补铁组（30例）。观察用药前后血红蛋白浓度、红细胞压积、血清铁、血清铁蛋白、转铁蛋白饱和度等疗效指标以及血清C反应蛋白、白介素-6、白介素-10、肿瘤坏死因子-α等炎症指标并监测不良反应。结果：8周后，静脉组血红蛋白水平及血清铁蛋白较治疗前明显改善（P〈0．01）；血浆及血清C反应蛋白，白介素-6，肿瘤坏死因子-α均较治疗前显著升高（P〈0．01或P〈0．05）。结论：静脉补铁有效改善患者的贫血及缺铁，也加剧了其炎症状态．     

静脉铁不同给药方案对维持性血液透析患者贫血及氧化应激反应的影响

目的观察静脉铁（蔗糖铁注射液）的不同给药方案（给药总剂量相同但给药次数和单次给药剂量不同）对维持性血液透析（MHD）患者贫血的疗效及其体内氧化应激反应的影响,寻求既方便、安全又经济、高效的给药方案。方法选择2006年～2007年于中国医科大学附属第四医院MDH患者70例,采用前瞻性、随机对照研究,随机分为5组,观察各组用药前后血红蛋白（Hb）浓度、红细胞压积（Hct）、血清铁（Si）、血清铁蛋白（SF）等疗效指标以及C反应蛋白（CRP）、血清中丙二醛（MDA）、过氧化物歧化酶（SOD）等微炎症和氧化指标,并监测不良反应。结果用药8周后,静脉补铁组Hb、HCt、SF水平与用药前相比均明显升高（P〈0．01）：而静脉补铁方案不同（100mg×10次,200mg×5次,500mg×2次）各组间比较无显著性差异（P〉0．05）。MHD患者治疗前血清SOD低于健康组（P〈0．01）,CRP和血清MDA高于健康组（P〈0．01,P〈0．01）。治疗8周后,静脉补铁组血清S01）均较治疗前显著下降（P〈0．05）,CRP和血清MDA均较治疗前显著升高（P〈0．05）,但静脉补铁方案不同各组间比较差异无统计学意义（P〉0．05）。结论蔗糖铁注射液三种不同静脉给药方法均有效改善MHD患者的贫血及缺铁,且疗效相当,以500mg×2次给药方案更为方便。长期静脉补铁可能对体内氧化应激产生一定影响,需进一步研究。     

炎性生物标志物对慢性阻塞性肺疾病患者死亡的影响

目的 探讨相关炎性生物标志物与慢性阻塞性肺疾病（COPD）患者死亡的相关性,为临床筛查高危病例提供依据.方法 2012年3月至2013年2月门诊和住院的COPD稳定期患者1 500例,随访15～27个月,以15个月截止,根据患者生存与死亡情况分组：死亡组154例,生存组1 346例.观察和比较两组病例临床资料、肺功能水平、呼吸困难程度和炎性生物标志物水平.结果 死亡组病例平均年龄（65.3±12.2）岁,显著高于生存组（60.2±11.5）岁;体质量指数（BMI）（19.8±5.4） kg/m2,显著低于生存组（23.2±5.6） kg/m2（t值分别为5.180、7.373,P均＜0.01）,但两组性别差异无统计学意义（P＞0.05）;死亡组与生存组病例1 s用力呼气容积（FEV1）、FEV1/用力肺活量（FEV1/FVC）、英国医学研究委员会呼吸困难量表（MMRC）评级分别为（1.1±0.4）L、（40.8±8.2）％、（2.8±1.3）级与（1.5±0.5）L、（46.3±11.2）％、（2.1±1.2）级,FEV1、FEV1/FVC均显著低于生存组,MMRC评级显著高于生存组,差异均有统计学意义（t值分别为9.582、5.914、6.797,P均＜0.01）;死亡组病例C反应蛋白（CRP）、白细胞介素（IL）6、IL-8、肿瘤坏死因子（TNF）α、中性粒细胞分别为（4.8±1.2） mg/L、（154.4±28.6） ng/L、（398.8±86.3）ng/L、（942.6±212.8）ng/L、（6.0±2.8）×109/L,显著高于生存组（3.4±1.1） mg/L、（112.8 ±23.6） ng/L、（332.7±76.3）ng/L、（1 482.8 ±223.6）ng/L、（5.1±1.5）×109/L,差异均有统计学意义（t值分别为14.818、20.242、10.041、29.684、6.299,P均＜0.01）.结论 包括CRP、IL-6、IL-8、TNF-α和中性粒细胞在内的炎性生物标志物是COPD患者死亡的危险因素,临床应重视对患者炎性生物标志物水平的监测,指导临床筛查高危病例,及时采取相应处理手段,改善预后.     

Contrasting feelings of helplessness in peritoneal and hemodialysis patients: a pilot study

This study compared perceptions of helplessness in hemodialysis and peritoneal dialysis patients using the Learned Helplessness Scale, a recently developed tool for measuring a newly developed nursing diagnosis. Although the sample sizes were small, a significantly greater sense of helplessness was reported by the hemodialysis group. The findings implied the need for nursing measures that enhance personal control in both groups of clients, but the hemodialysis subjects demonstrated a greater need.     

Kinetics of intravenous mezlocillin in chronic hemodialysis patients.

The kinetics of intravenous mezlocillin was studied in 8 patients with creatinine clearances under 7 ml/min who were undergoing chronic hemodialysis. Kinetic parameters were determined using a 2-compartment linear model. The mezlocillin serum half-life (t 1/2) in these patients ranged from 2.9 to 7.8 hr (mean, 5.4). The t 1/2 decreased to 1.57 +/- 0.09 hr during dialysis. Approximately 18% of the dose was recovered in the dialysate in 4 hr of dialysis. There was a 30% reduction per hour in serum concentration. The kinetics of mezlocillin, due to removal by nonrenal mechanisms, more closely resemble the kinetics of penicillin G and ampicillin than of carbenicillin and ticarcillin. A dosage schedule for use of intravenous mezlocillin in patients undergoing hemodialysis is presented.     

Reliability of oxidative stress biomarkers in hemodialysis patients: a comparative study.

BACKGROUND: Oxidative stress (OS) is considered to play a major role in the development of end-stage renal disease (ESRD) complications. However, conflicting and inconsistent data have been reported on OS in ESRD patients. Our aim was to investigate the reliability of the most popular non-enzymatic plasma OS biomarkers in ESRD. METHODS: Vitamins A (VitA), E and C (VitC), uric acid, plasma antioxidant and ferric-reducing potential (PAP and PRP), thiols (SH), malondialdehyde (MDA) and lipid hydroperoxides (HPO) were determined before and after dialysis in plasma from 33 ESRD patients on hemodialysis, hemodiafiltration or peritoneal dialysis and 20 control subjects. RESULTS: In ESRD patients, high PRP and normal PAP values were positively correlated with VitC levels. After dialysis, PRP levels decreased, while unchanged PAP levels correlated positively with high VitA and transiently recovered SH values. All patients showed high levels of both MDA and cholesterol-normalized HPO. However, while the former significantly decreased after dialysis, the latter were unaffected by treatment. Paradoxical correlations of MDA with both VitA and HPO were found. CONCLUSIONS: Plasma PRP and MDA levels may be dramatically affected by both uremia and dialysis; their use in ESRD patients may therefore lead to OS misevaluation and should be avoided. More reliable results can be obtained using physiologically relevant OS functional tests, such as PAP, and early biomarkers of OS damage, such as SH and HPO.     

品管圈活动在降低血液透析中补铁所致的透析机空气报警率中的应用

目的:探讨品管圈活动在降低血液透析补铁所致的透析机空气报警中的应用,以提高血液透析病人蔗糖铁使用的安全性,保证病人血液透析的顺利进行。方法:由血液净化中心8名医护人员自愿组建品管圈,选定降低血液透析中补铁所致的透析机空气报警率为活动主题,总结分析透析过程中静脉点滴蔗糖铁所致的透析机空气报警原因,同时制定和实施相应的护理对策。结果:应用品管圈活动后,静脉点滴蔗糖铁所致的空气报警率较活动前明显降低,差异有统计学意义(P0.05)。结论:开展品管圈活动,降低了血液透析中静脉点滴蔗糖铁所致的透析机空气报警次数,提高了圈员的团队精神和质量管理能力。     

Pharmacokinetics of intravenous piperacillin in patients undergoing chronic hemodialysis.

The pharmacokinetic properties of piperacillin, a piperazine derivative of ampicillin, were determined in seven patients with creatinine clearances less than 7 ml/min who were undergoing chronic, intermittent hemodialysis. A two-compartment linear model was used to analyze the data. Mean elimination half-life was 1.26 +/- 0.1 h; the mean elimination constant was 0.95 +/- 0.08 h-1; the mean volume of distribution was 0.16 +/- 0.02 liters/kg of body weight; the mean volume of the central compartment was 0.10 +/- 0.01 liters/kg of body weight; and the mean clearance was 0.09 +/- 0.01 liters/h per kg of body weight. Mean elimination half-life while off dialysis of 2.1 h.     

Serum erythropoietin concentrations and iron status in patients on chronic hemodialysis.

We studied the relationship between serum erythropoietin (EPO) concentration and iron status in 67 patients undergoing chronic hemodialysis. Serum concentrations of EPO were measured by RIA with recombinant human EPO. The geometric mean of the serum EPO concentration was 10.9 int. units/L (mean +/- SD range = 7.8 - 15.3 int. units/L) in hemodialysis patients, considerably lower than that in normal subjects (12.9 int. units/L). We found no significant correlation between concentrations of serum EPO and hemoglobin in hemodialysis patients, but found a significant negative correlation between serum concentrations of EPO and iron in hemodialysis patients. Moreover, we also found a significant positive correlation between the EPO concentration and the unsaturated iron-binding capacity (UIBC) in serum, and a significant negative correlation between the serum concentrations of EPO and ferritin in hemodialysis patients. Several patients who had relatively high EPO concentrations for hemodialysis patients also had low iron concentrations, high UIBC values, and low ferritin concentrations. These findings suggest that iron was utilized even at these EPO concentrations, which were very low for the degree of anemia observed in the hemodialysis patients.     

静脉与口服维生素C对维持性血液透析患者铁超负荷的疗效观察

目的观察静脉与口服维生素C（VitC）治疗维持性血液透析（MHD）铁超负荷患者疗效。方法选择中南大学湘雅二医院肾内科行血液透析患者血清铁蛋白（SF）〉800ng／ml和（或）转铁蛋白饱和度（TSAT）〉50％30例，随机分为3组，对照组（n=10）、口服组（n=10）和静脉组（n=10）。观察用药前后SF、TSAT、血红蛋白（Hb）、红细胞压积（Hct）和血浆丙二醛（MDA）的变化。结果治疗12周后，静脉组SF、TSAT降低，Hb、Hct升高，与对照组、口服组差异有显著性（P〈0．01）；口服组SF、TSAT、Hb、Hct稍有改善，与对照组比较无统计学意义（P〉0．05）而PMDA、PSOD无统计学意义。结论MHD铁超负荷患者静脉滴注VitC优于口服。     

Alterations of serum lipid and inflammatory cytokine profiles in patients with coronary heart disease and chronic periodontitis: a pilot study

Serum lipid and inflammatory cytokine profiles were assessed in 124 in-patients with coronary heart disease (CHD) (CHD group) and 43 inpatients with no evidence of CHD (control group). In all patients, research questionnaires and examinations of periodontal health were conducted and venous blood samples were analysed. Both groups were divided into two subgroups according to the presence or absence of chronic periodontitis in individual patients. The prevalence of chronic periodontitis was higher in patients from the CHD group than in the control group. Levels of total cholesterol, triglycerides, low-density lipoprotein, oxidized low-density lipoprotein, high-sensitivity C-reactive protein, interleukin-6 and tumour necrosis factor-α were significantly higher in CHD patients with chronic periodontitis than in those without periodontitis. In conclusion, chronic periodontitis may be associated with CHD.     

Clinical practice guidelines for maintaining adequate iron status with intravenous iron dextran in hemodialysis patients

While oral iron can be used to manage iron stores in some hemodialysis patients, most require intravenous iron supplementation. Maintenance of iron balance in these patients is critical, since patients with end stage renal disease often suffer from anemia caused by inadequate production of red blood cells and iron deficiency resulting from chronic blood loss. Using guidelines that include maintenance dosing ensures sustained adequate iron stores and maximizes the effects of rHuEPO therapy. Easy-to-administer clinical practice guidelines for repletion and maintenance of iron stores are presented here.