静脉铁剂与口服铁剂治疗维持性血液透析患者不宁腿综合征的疗效比较

目的比较静脉铁剂与口服铁剂治疗血液透析患者不宁腿综合征(RLS)的疗效。方法 46例行维持性血液透析的RLS患者,按随机数字表法分为两组各23例,口服铁剂组口服多糖铁复合物胶囊,每次150 mg,2次/日;静脉铁剂组静脉滴注蔗糖铁注射液,每次100 mg,1次/周,总量1200 mg。两组均治疗12周。比较两组患者治疗前后血红蛋白(Hb)、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)、RLS评分、PSQI评分等指标。结果两组治疗后SF、Fe、TSAT、Hb均明显升高(P0.05);口服铁剂组RLS评分和PSQI评分与治疗前比较差异无统计学意义(P0.05),而静脉铁剂组与治疗前比较差异有统计学意义(P0.05)。静脉铁剂组SF、Fe、TSAT、Hb均高于口服铁剂组,RLS、PSQI评分均低于口服铁剂组(P0.05)。治疗过程中所有患者均无明显不良反应。结论蔗糖铁注射液能明显缓解血液透析患者不宁腿症状,并改善睡眠质量。     

不同途径补铁对维持性血液透析后贫血及铁缺乏的疗效比较

目的:探讨口服与静脉途径补充铁剂对维持性血液透析(MHD)患者贫血和铁缺乏的疗效。方法:将行MHD的71例随机分为静脉补铁组(静脉组)24例、口服补铁组(口服组)27例和未补铁组(对照组)20例。3组同时应用重组人红细胞生成素(r-EPO),用药前后监测红细胞(RBC)、血红蛋白(Hb)、红细胞压积(HCT)、血清铁、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT),并观察不良反应。结果:治疗后8周,静脉组RBC、Hb、HCT水平较治疗前明显升高,差异有统计学意义(P<0.05),亦较口服组及对照组明显升高,差异均有统计学意义(P<0.01);口服组RBC、Hb较治疗前明显升高,对照组RBC、Hb均较治疗前改善,但差异无统计学意义(P>0.05)。治疗后8周,静脉组SF及TSAT均较治疗前升高,SF差异有统计学意义(P<0.01),TSAT差异无统计学意义(P>0.05);与口服组及对照组比较,差异均有统计学意义(P<0.01)。口服组及对照组治疗前后及组间SF、TSAT比较,差异均无统计学意义(P>0.05)。结论:MHD者均存在不同程度铁缺乏,静脉补充铁剂联合r-EPO可有效改善其贫血及铁缺乏状态,疗效优于口服补铁方式。     

生血宁与蔗糖铁联合左卡尼汀对MHD贫血患者氧化应激及红细胞参数的影响

[目的]探讨生血宁与蔗糖铁联合左卡尼汀对维持性血液透析(MhD)肾性贫血患者氧化应激及红细胞参数的影响.[方法]MhD肾性贫血患者70例,随机分为两组,各35例,对照组给予蔗糖铁+左卡尼汀,观察组给予生血宁+左卡尼汀治疗,比较两组治疗前后过氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA),血清铁蛋白(SF)、血清转铁蛋白饱和度(TSAT)及血红蛋白(Hb)、红细胞比容(HCT),血清超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及血肌酐、血钙、血磷等指标变化,记录不良反应.[结果]观察组治疗前后SOD、GSH-Px、MDA比较无明显变化(P>0.05),对照组治疗后SOD、GSH-Px较治疗前明显下降(P<0.05),MDA显著增加(P<0.05);治疗后观察组hs-CRP、IL-6、TNF-α较治疗前无明显变化,而对照组上述指标有明显增加趋势(P<0.05);治疗后观察组SF(413.15±1.87)ng/L、TSAT(28.59±1.74)%较对照组显著增加(P<0.05),两组Hb、HCT均明显增加(P<0.05),但组间比较差异无显著性(P>0.05);治疗后两组血肌酐、血钙增加,血磷降低,组间比较差异无显著性(P>0.05);观察组不良反应发生率低于对照组(P<0.05).[结论]生血宁与蔗糖铁联合左卡尼汀对MhD肾性贫血患者疗效相似,前者铁代谢指标优于后者,且不会加剧氧化应激及微炎症反应,且不良反应轻,值得在临床推广应用.     

阿托伐他汀对血液透析患者血清铁调素水平的影响

目的前瞻性观察阿托伐他汀对维持性血液透析(MHD)患者血清铁调素水平的影响。方法选择32例维持性血液透析患者,随机分为阿伐他汀组(16例)和常规治疗组(16例)。阿伐他汀组每晚给予阿托伐他汀20 mg共12周,常规治疗组不使用阿托伐他汀及其他调脂药。观察两组实验前后血清铁调素、超敏CRP(hs-CRP)、白介素6(IL-6)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血红蛋白(Hb)、血细胞比容(Hct)、铁蛋白(SF)、转铁蛋白饱和度(TSAT)等指标的变化。同时选取健康对照者15例,测定血清铁调素、hsCRP及IL-6水平,与MHD患者做比较。结果与健康对照组相比,32例MHD患者血清铁调素、hsCRP、IL-6水平均显著性升高(P0.01)。12周后,阿伐他汀组较前相比,铁调素下降20.5%(P0.05)、IL-6下降32.2%(P0.05)、hsCRP下降31.7%(P0.05);较常规治疗组治疗后相比,铁调素下降13.4%(P0.05)、IL-6下降34.2%(P0.05),hsCRP下降29.9%(P0.05)。同时12周后阿伐他汀组TG、TC、LDL-C均较治疗前明显降低(P0.05),HDL-C、Hb、Hct较治疗前明显升高(P0.05)。而常规治疗组各项及治疗组TSAT、SF值组内及组间比较均无统计学差异。结论口服常规剂量阿托伐他汀可降低MHD患者血清铁调素水平。     

维持性血液透析患者铁调素与肾性贫血缺铁状态的相关性

[目的]探讨维持性血液透析(maintenance hemodialysis,MHD)患者铁调素与肾性贫血缺铁状态的相关性.[方法]选择MHD患者54例,按转铁蛋白饱和度(TSAT)和血清铁蛋白(SF)水平分为功能性铁缺乏组29例与绝对性铁缺乏组25例,另外收集健康志愿者30例为对照组,比较三组间铁调素、SF及高敏C反应蛋白(hs-CRP)及白介素-6(IL-6)等指标,分析铁调素与hs-CRP、IL-6的相关性.[结果]三组铁调素、hs-CRP及IL-6比较差异有统计学意义(P<0.05);Pearson相关分析显示铁调素与SF、IL-6成正相关(P<0.05);逐步回归分析显示hs-CRP、铁调素与SF密切相关.[结论]铁调素可反映MHD患者缺铁及炎症状态.     

普拉克索对血液透析患者不宁腿综合征的疗效研究

目的探讨普拉克索对治疗维持性血液透析患者不宁腿综合征(RLS)的疗效。方法将24例维持血液透析RLS患者两两配对,随机分入对照组和治疗组。对照组维持现有治疗方案。治疗组在现有治疗方案基础上给予普拉克索(0.25~0.75mg/d,口服)。治疗8周后,比较两组患者治疗前后国际RLS研究组评分量表(IRLSSGRS)评分结果的变化。结果治疗前两组患者IRLSSGRS评分比较差异无统计学意义(P0.05)。对照组治疗前后IRLSSGRS评分比较差异无统计学意义(P0.05)。治疗组IRLSSGRS评分较治疗前明显下降[(15.67±2.77)分vs.(25.33±6.37)分,P0.05],且低于对照组治疗后评分结果[(15.67±2.77)分vs.(24.33±6.34)分,P0.05]。结论普拉克索治疗维持性血液透析RLS患者疗效较为显著。     

静脉用蔗糖铁治疗血液透析患者肾性贫血的疗效观察及护理

目的探讨静脉补铁对肾性贫血的疗效及护理。方法 46例维持血液透析的贫血患者分为静脉和口服两组,治疗8周后观察其Hb、RBC等各项指标的变化。结果静脉组治疗前后的Hb为(70.05±16.19)g/L及(86.19±13.04)g/L,RBC为(2.51±0.56)×1012/L及(3.08±0.65)×1012/L,Hct为0.218±0.051及0.274±0.046,SF为(215.43±98.31)μg/L及(510.99±136.96)μg/L,TSAT为(21.03±5.83)%及(33.51±7.47)%,差异具有统计学意义(P均<0.01);且Hb、Hct、SF、TSAT增高幅度明显高于口服组(P<0.05)。口服组治疗前后各指标均无统计学差异。结论静脉补铁治疗血液透析患者肾性贫血疗效优于口服铁剂。     

静脉铁剂治疗维持性血液透析患者肾性贫血的临床观察

目的比较静脉应用蔗糖铁与口服琥珀酸亚铁联合使用促红细胞生成素（EPO）治疗维持性血液透析（MHD）患者肾性贫血的疗效与安全性。方法 40例患者按随机数字表法分为静脉组（静脉滴注蔗糖铁＋EPO）和对照组（口服琥珀酸亚铁＋EPO）,每组20例,共观察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对照组,差异有统计学意义（P〈0.01）。静脉组无明显不良反应,对照组2例（10.0%）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。     

维持性血液透析患者肾性贫血纠正情况及其影响因素分析

目的探讨维持性血液透析(MHD)患者肾性贫血纠正情况及其影响因素。方法收集2017年9月至2019年9月行MHD治疗患者188例。根据血红蛋白水平分为A、B、C、D四组,比较各组间基线水平及CRP、TSAT、SF、preALB、ALB、iIPTH、Ca^2+、P^3-、TG、TC等实验室指标的差异,分析影响肾性贫血达标的影响因素。结果preALB、ALB、TSAT水平,A组>B组>C组>D组逐渐降低,四组比较差异有统计学意义(P<0.05)。iPTH、P^3-、CRP水平,A组0.05)。结论MHD患者肾性贫血治疗达标率较低,透前CRP、TSAT、preALB、ALB、iPTH、p-是MHD患者贫血不达标的影响因素。     

血液净化患者不同途径补充铁剂的临床疗效观察

目的探讨血液净化患者口服及静脉给予铁剂后短期临床疗效。方法选取洛阳市第三人民医院血液净化科长期规律透析患者50例,均常规应用促红素,随机分为两组,每组25例,A组静脉使用蔗糖铁,B组口服琥珀酸亚铁。治疗前后分别检测红细胞(RBC)、血红蛋白(Hb)、红细胞压积(HCT)、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)、门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血尿素氮、肌酐及观察临床症状的改变。结果两组在治疗后对比BUN、Cr、AST的数值无明显变化,ALT轻度升高,但差异无统计学意义(P>0.05);治疗后对比RBC、Hb、HCT、SF、TSAT数值,静脉给予铁剂组明显高于口服给予铁剂组,差异具有统计学意义(P<0.05)。结论血液净化患者静脉补铁可使SF和TSAT显著改善,Hb及HCT明显升高。     

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。     

维持性血液透析患者贫血治疗中铁调素的变化和影响因素

目的探讨铁调素在维持性血液透析（Maintenance hemodialysis,MHD）患者贫血治疗中对铁稳态的调节作用,及与铁剂补充、红细胞生成素（erythropoietin,EPO）应用的相互影响,探求恢复机体铁稳态的治疗方法。方法选取同济大学附属东方医院肾内科血液净化中心的32例MHD患者,HD时间6月以上,血红蛋白低于110g／L,给予常规补铁及EPO治疗,应用ELISA方法测定患者血清铁调素水平,分析其与铁代谢指标血清铁,血清铁蛋白（Serum ferritin,SF）与转铁蛋白饱和度（Transferrin saturation,TSAT）以及红细胞生成、铁剂补充和EPO应用的相关性及相互作用。结果MHD患者血清铁调素水平显著高于正常对照组（324±124．2ng／L比72．4±12．3ng／L,P〈0．001）,相关性分析显示铁调素与血清铁、SF及TSAT正相关（r分别为0．68,0．62,0．7,P值分别为0．005,0．004,0．001）,与网织红细胞计数呈负相关（r=0．63,P=0．015）。常规血液透析可有效清除铁调素,但于2周后血液透析前血清铁调素水平几乎可恢复至原水平。在贫血治疗中,EPO应用而非静脉补铁可显著降低铁调素水平,改善贫血的同时促进了铁的利用。结论MHD患者铁调素显著升高,参与了铁代谢紊乱的发病和红细胞生成的调控;及时有效的清除铁调素和足量EPO应用可改善红细胞生成及铁的循环利用,恢复机体铁稳态,防止铁超载对机体的进一步损伤。     

富马酸亚铁多库酯钠胶囊和多糖铁复合物胶囊 对终末期肾病肾性贫血患者氧化应激的影响比较

目的 比较富马酸亚铁多库酯钠胶囊和多糖铁复合物胶囊对终末期肾病肾性贫血患者氧化应激的影响.方法 前瞻性选取2017年9月至2019年9月在大庆市人民医院接受维持性血液透析治疗的120例终末期肾病贫血患者,随机数字表法分为对照组和治疗组,各60例.所有患者在常规维持血液透析的基础上接受重组人红细胞生成素治疗,对照组患者口...     

Restless legs syndrome and near-infrared light: An alternative treatment option

There are few treatment options in managing restless legs syndrome (RLS); the most frequently used are dopaminergic drugs and movement. New treatment options are highly sought after. This study evaluated the effectiveness of monochromatic near-infrared light treatment in decreasing symptoms associated with RLS. The design used was 2×6 repeated-measures design with two groups (treatment and control) and six repeated measures (baseline, weeks 1–4, and posttreatment). Data collection took place in the university modalities laboratory. Thirty-four volunteers with symptoms of RLS were randomly assigned to a treatment or control group. Over a 4-week period subjects underwent twelve 30-min treatments to their lower legs with near-infrared light. The International RLS rating scale (IRLS) was used to assess and track patient symptoms. There was a steady decrease in symptoms associated with RLS over the 4 weeks in the treatment group. After 4 weeks of treatment the treatment group had a significantly greater improvement in restless legs syndrome symptoms than the control group (p<0.001); improvement was still significant after 4 weeks posttreatment compared to baseline (p<0.001). Treatment with near-infrared light does decrease symptoms associated with RLS as demonstrated in lower IRLS scores. This new noninvasive method of treating RLS might become a valuable new management option. More research is needed to determine the mechanism(s) behind infrared light treatment and RLS.     

Restless legs syndrome and near-infrared light: An alternative treatment option

There are few treatment options in managing restless legs syndrome (RLS); the most frequently used are dopaminergic drugs and movement. New treatment options are highly sought after. This study evaluated the effectiveness of monochromatic near-infrared light treatment in decreasing symptoms associated with RLS. The design used was 2×6 repeated-measures design with two groups (treatment and control) and six repeated measures (baseline, weeks 1-4, and posttreatment). Data collection took place in the university modalities laboratory. Thirty-four volunteers with symptoms of RLS were randomly assigned to a treatment or control group. Over a 4-week period subjects underwent twelve 30-min treatments to their lower legs with near-infrared light. The International RLS rating scale (IRLS) was used to assess and track patient symptoms. There was a steady decrease in symptoms associated with RLS over the 4 weeks in the treatment group. After 4 weeks of treatment the treatment group had a significantly greater improvement in restless legs syndrome symptoms than the control group (p<0.001); improvement was still significant after 4 weeks posttreatment compared to baseline (p<0.001). Treatment with near-infrared light does decrease symptoms associated with RLS as demonstrated in lower IRLS scores. This new noninvasive method of treating RLS might become a valuable new management option. More research is needed to determine the mechanism(s) behind infrared light treatment and RLS.     

阿托伐他汀对血液透析患者血清铁调素水平的影响简

目的 前瞻性观察阿托伐他汀对维持性血液透析（MHD）患者血清铁调素水平的影响.方法选择32例维持性血液透析患者,随机分为阿伐他汀组（16例）和常规治疗组（16例）.阿伐他汀组每晚给予阿托伐他汀20 mg共12周,常规治疗组不使用阿托伐他汀及其他调脂药.观察两组实验前后血清铁调素、超敏CRP（hs-CRP）、白介素6（IL-6）、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、血红蛋白（Hb）、血细胞比容（Hct）、铁蛋白（SF）、转铁蛋白饱和度（TSAT）等指标的变化.同时选取健康对照者15例,测定血清铁调素、hsCRP及IL-6水平,与MHD患者做比较.结果与健康对照组相比,32例MHD患者血清铁调素、hsCRP、IL-6水平均显著性升高（P〈0.01）.12周后,阿伐他汀组较前相比,铁调素下降20.5%（P〈0.05）、IL-6下降32.2%（P〈0.05）、hsCRP下降31.7%（P〈0.05）;较常规治疗组治疗后相比,铁调素下降13.4%（P 〉0.05）、IL-6下降34.2%（P〈0.05）,hsCRP下降29.9%（P〈0.05）.同时12周后阿伐他汀组TG、TC、LDL-C均较治疗前明显降低（P〈0.05）,HDL-C、Hb、Hct较治疗前明显升高（P〈0.05）.而常规治疗组各项及治疗组TSAT、SF值组内及组间比较均无统计学差异.结论口服常规剂量阿托伐他汀可降低MHD患者血清铁调素水平.     

Intravenous iron sucrose in peritoneal dialysis patients with renal anemia.

OBJECTIVE: To explore the safety and efficacy of intravenous (IV) iron sucrose in maintenance peritoneal dialysis (PD). DESIGN: Randomized, controlled, parallel-group single-center trial. SETTING: Blood Purification Center of Chaoyang, Beijing Capital University of Medical Science, China. METHODS: 46 patients on PD were involved in this trial. 26 patients received IV iron sucrose (200 mg iron) once per week for 4 weeks then once every other week for a further 4 weeks. The other 20 patients received oral ferrous succinate, 200 mg three times per day, for 8 weeks. Hemoglobin, hematocrit, serum ferritin (SF) level, and transferrin saturation (TSAT) were assessed at baseline and then again after 2, 4, and 8 weeks of treatment. RESULTS: There were no differences between the IV and oral groups in terms of sex, age, duration of PD, mean dialysate dosage per day, erythropoietin dosage per week, or hematological parameters at baseline. After 4 and 8 weeks of treatment, mean Hb and Hct were significantly increased in the IV group and were also significantly higher than those in the oral group. Levels of SF and TSAT were also significantly increased in the IV group, and significantly higher than in the oral group. After 8 weeks, the response rate in the IV group was 94.8%, which was significantly higher than that in the oral group. The mean erythropoietin dose was significantly lower in the IV group than in the oral group. Hb, Hct, SF, and TSAT levels were maintained between 4 and 8 weeks in the IV group despite the decrease in dose frequency. There were no adverse events with IV iron. Eight patients in the oral group had adverse gastrointestinal effects. CONCLUSION: IV iron sucrose is safe in PD patients. It increases Hb levels and serum iron parameters more effectively than oral iron; it is well tolerated and can permit reductions in the required dose of erythropoietin.     

静脉用右旋糖酐氢氧化铁注射液治疗腹膜透析患者肾性贫血的临床研究

目的评价右旋糖酐氢氧化铁注射液治疗腹膜透析患者铁缺乏的有效性及安全性。方法选择第二军医大学附属长海医院肾内科59例长期不卧床腹膜透析(CAPD)患者,肾性贫血程度:血红蛋白(Hb)60～90g/L,或红细胞压积(Hct)0.18%～0.27%,随机分为静脉组与口服组,分别采用静脉注射右旋糖酐氢氧化铁及口服琥珀酸亚铁进行补铁治疗,总疗程8周。检测治疗前治疗后8周时血清铁指标、红细胞相关指标及生化指标,并对不良反应进行监测。结果①共50例完成本临床研究,其中静脉组与口服组各25例,两组患者年龄、性别、贫血程度、血清铁指标及促红细胞生成素(EPO)用量相匹配。②治疗8周时,静脉组Hb及Hct显著升高,分别为(24.1±17.9)%和(27.2±19.7)%,幅度明显高于口服组[(12.1±16.5)%和(15.8±11.8)%],P<0.001。③治疗8周时,两组血清铁蛋白(SF)与转铁蛋白饱和度(TSAT)均较治疗前显著升高,且静脉组升高幅度[SF(487.3±390.8)%,TSAT(93.1±87.0)%]明显高于口服组[SF(178.9±271.7)%,TSAT(38.9±41.7)%],P<0.001。④治疗8周时,静脉组血清白蛋白及血清钾较治疗前升高,白蛋白由(35.7±6.1)g/L升至(39.4±5.9)g/L,血清钾由(4.1±0.7)g/L升至(4.9±0.8)g/L,P<0.01。两组治疗前后血白细胞及其它生化指标均相近。⑤静脉组2例有不良反应,其中1例轻微心悸,1例轻度胃肠道反应。口服组7例出现明显胃肠道症状。静脉组总不良反应发生率(2/25,8.0%)明显低于口服组(7/25,28.0%),P<0.01。结论①静脉注射右旋糖酐氢氧化铁可有效纠正CAPD患者的铁缺乏、提高铁利用率及EPO的治疗效果。②静脉注射右旋糖酐氢氧化铁临床应用不良反应发生率低、安全性良好。