维持性血液透析患者铁代谢状况的初步分析

目的调查维持性血液透析患者铁代谢的情况。方法采用横断面研究。以2010年6月首都医科大学附属北京朝阳医院血液净化中心76例维持性透析患者为研究对象,收集患者临床资料、血清铁代谢指标、血常规、铁剂和红细胞生成素应用情况,分析患者铁代谢状态及其与铁剂应用情况的关系。结果 76例维持性血液透析患者中有38例(50.0%)存在铁缺乏,其中功能性铁缺乏23例、绝对铁缺乏13例,发生率分别为30.3%和17.1%。76例维持性血液透析患者中,血清铁蛋白200μg/L者17例、200～800μg/L者53例、800μg/L者6例,其发生率分别为22.4%、69.7%和7.9%。血清铁蛋白800μg/L的6例透析患者合并有功能性铁缺乏的患病率为100%。铁缺乏与无铁缺乏患者的血红蛋白水平分别为(109.9±13.0)g/L和(116.3±9.5)g/L,二者差异有统计学意义(t=2.461,P=0.016);且存在铁缺乏的透析患者每周红细胞生成素用量明显高于无铁缺乏的透析患者,分别为(118.9±44.5)U/(kg·周)和(97.7±28.7)U/(kg·周),差异有统计学意义(t=2.490,P=0.015)。76例维持性血液透析患者中,使用静脉铁剂者蔗糖铁(112.0±33.2)mg/月]25例,使用口服铁剂者(琥珀酸亚铁0.2tid)51例。使用静脉铁剂者的铁缺乏患病率明显低于口服铁剂者,使用静脉铁剂者血清铁蛋白较口服铁剂者明显增高,差异均有统计学意义(P0.05)。结论维持性血液透析患者铁缺乏的发生率较高,主要表现为功能性铁缺乏。存在铁缺乏的透析患者须用较大剂量的红细胞生成素方可维持其血红蛋白水平。使用静脉铁剂可减少铁缺乏的发生。

Iron metabolism state in maintenance hemodialysis patients

Objective To investigate the state of iron metabolism in maintenance dialysis （MHD） patients. Methods Seventy-six patients on maintenance dialysis were involved in this cross-sectional study on June, 2010. The following data were collected： clinic data, serum ferritin and transferring saturation, hemoglobin, iron and erythropoietin preparations, etc. T test and γ^2 test were performed for statistics. Results Among 76 MHD patients, 38 （50.0%） MHD patients had iron deficiency. The prevalence of functional and absolute iron deficiency were 30.3% and 17.1%, respectively. The prevalence of serum ferritin less than 200 ug/L, between 200 to 800 ug/L and more 800 ug/L were 22.4%, 69.7% and 7.9%, respectively. All the 19 MHD patients with serum ferritin more than 800 ug/L had functional iron deficiency. The level of hemoglobin in MHD patients with iron deficiency was （109.9±13.0） g/L, which was lower than that in MHD patients without iron deficiency whose hemoglobin were （116.3±9.5）g/L. And the dosage of EPO in MHD with iron deficiency was significantly higher than that in MHD patients without iron deficiency （118.9±44.5）U/（kg · W ） vs （97.7±28.7）U/（kg· W）, t=2.490, P=0.015）. The prevalence of iron deficiency in MHD patients received intravenous （i.v.） iron was significantly lower than than in MHD patients received oral iron. But the prevalence of high serum ferritin in MHD patients received i.v. iron was significantly higher than that MHD patients received oral iron. Conclusions The prevalence of iron deficiency in MHD patients was quite high. The main iron deficiency pattern of MHD patients was functional iron deficiency. The MHD patients with iron deficiency must receive more EPO to maintain their hemoglobin level. It was effective to decrease the prevalence of iron deficiency to receive i.v. iron for MHD patients.