不同给药途径补铁对肾性贫血的疗效及促红细胞生成素用量的影响

目的:比较静脉和口服补铁纠正肾性贫血的疗效,以及对重组人促红细胞生成素(rHuEPO)用量的影响。方法:260例未达到贫血治疗靶目标的血液透析病人,随机分为静脉铁组和口服铁组,前者给予右旋糖酐铁100 mg,在透析中静脉输入,每周2次,5 wk后改为100 mg·2 wk~(-1),至12 wk。后者给予琥珀酸亚铁200 mg,po,tid,连续服用12 wk。结果:治疗12 wk后,静脉铁组(n=165)血红蛋白(Hb)增长(21±s 13)g·L~(-1),血细胞比容(Hct)增长0．07±0．03,血清铁蛋白(SF)增长(334±134)μg·L~(-1),运铁蛋白饱和度(TSAT)增长(9±6)%,均P＜0．01。口服铁组(n=84)中,Hb和Hct分别增长(14±27)g·L~(-1)和0．032±0．010,P＜0．01;而SF和TSAT无明显变化,P＞0．05。以上2组指标变化比较差异均有非常显著意义(P＜0．01)。静脉铁组rHuEPO用量为(6 530±2 234)IU·wk~(-1),显著少于口服铁组(8839±1922)IU·wk~(-1)(P＜0．01)。静脉铁组纠正贫血达标率为Hb达标73．9%和Hct达标78．8%,均高于口服铁组(Hb达标43%和Hct达标40%,P＜0．01)。静脉铁组的不良反应发生率为1．2%,口服铁组为6%。结论:静脉应用右旋糖酐铁比口服琥珀酸亚铁能够更安全、有效地纠正肾性贫血,并且可以显著减少rHuEPO的用量。

Comparing effects of intravenous and oral iron supplementations and adjustment dosages of recombinant human erythropoietin in renal anemia

AIM:To compare the clinical significant differences of the two adjustment dosages of the re- combinant human erythropoietin(rHuEPO)in hemodialysis(HD)patients with intravenous iron-dextran and o- ral iron-ferrous succinate supplementations.METHODS:Two hundred and sixty patients on maintenance HD with rHuEPO treatment,in addition oral and intravenous iron supplementation,were enrolled in a multi-center, prospective,randomized,controlled trial and divided into two groups.In intravenous group,iron-dextran 100 mg was infused through the veins of end dialyser two times per week for 5 wk,then followed by 100 mg·2 wk~(-1)for 12 wk.In oral group,iron-ferrous succinate 200 mg,po,tid for 12 wk.RESULTS:Two hundred and forty-nine patients completed the trial including 165 patients in intravenous group,and 84 patients in oral group.After 12 wk treatment,mean hemoglobin(Hb),hematocrit(Hct),serum ferritin(SF),transferring saturation(TSAT)in the intravenous group increased significantly greater than those in the oral group((21±s 13)g·L~(-1),0.07±0.03,(334±134)μg·L~(-1),(9±6)%,vs(14±27)g·L~(-1),0.032±0.010,-(9±73)μg·L~(-1),(0±9)%,respectively,P＜0.01).The dosages of rHuEPO used in the intravenous group were much less than those in the oral group((6530±2234)IU·wk~(-1)vs(8839±1922)IU·wk~(-1),P＜0.01). The effective rates in the intravenous group were higher than those of oral group(Hb:73.9% vs 43%,P＜0.01,Hct:78.8% vs 40%,P＜0.01).The rate of adverse reactions were 1.2% in intravenous group and 6% in oral group.CONCLUSION:Intravenous iron-dextran administration is more effective and safe than oral ferrous succinate intake for the treatment of renal anemia in HD patients,and saves the application dosage of rHuEPO significantly.