慢性炎症状态对维持性血透患者静脉补铁的影响

目的观察慢性微炎症状态对血透患者静脉补铁后体内铁代谢指标的影响.方法选择48例维持性血透患者,静脉补充铁剂(科莫非),每次100 mg稀释后静脉滴注,每周2次,共10次,观察8周,根据C反应蛋白(CRP)值分为2组:CRP增高组(n=26)和CRP降低组(n=22),观察治疗前后血红蛋白(Hb)、红细胞压积(HCT)、血清铁蛋白(SF)、血清总铁结合力(TIBC)及常规生化指标、Kt/V.结果经补铁后CRP增高组Hib、HCT升高程度明显低于CRP降低组(P＜0.05),而CRP增高组SF(11.68±3.63μmol/L)明显高于CRP降低组(7.34±2.12 μmol/L),CRP降低组TIBC(68.34±12.16μmol/L)下降显著高于CRP增高组(51.16±9.83 μmol/L).结论研究表明慢性炎症状态下维持性血透患者对铁剂治疗反应降低,但易于发生高铁蛋白血症,导致体内铁堆积.

The Influence of Chronic Microinflamation State to Intravenous Iron Treatment in Maintenance Hemodialysis Patients

Objective To investigate the effect of chronic microinflamation state to intravenous iron treatment in maintenance hemodialysis(MHD) patients. Methods 48 MHD patients were treated with iron-dextran intravenously with the dose of 100 mg,twice a week for 10 times. All the MHD patients were devided into 2 groups according to their C-reactive protein(CRP)level, that is, CRP elevated group(n=26) and CRP decreased group(n=22).Hemoglobin(Hb),hematocrit(Hct),serum ferritin(SF),total iron binding capacity(TIBC),blood biochemistry and Kt/V were measured before and after treatment respectively. Results Hb and Hct were increased in both groups,while the increment was more markedly in CRP decreased group than CRP increased group(P<0.05).SF level was higher in CRP elevated group than CRP decreased group. The decrease of TIBC was more markedly in CRP decreased group than CRP increased group(P<0.05).Conclusions Chronic microinflamation state may lead to low treatment reaction to MHD patients, while it is easy to cause methemoglobinemia, leading to iron accumulation.