促红细胞生成素联合静脉铁剂治疗肾性贫血的疗效分析

目的观察并比较静脉注射科莫非(右旋糖酐氢氧化铁)联合促红细胞生成素治疗维持性血液透析(HD)患者铁缺乏的临床疗效。方法采用前瞻性、随机对照研究。选择44例慢性肾衰竭维持性HD患者,随机分为静脉注射右旋糖酐氢氧化铁组(静脉组)与口服琥珀酸亚铁组(口服组),静脉组21例,口服组23例,总疗程8周。检测治疗前后血清铁、红细胞相关指标及生化指标,观察疗效及促红细胞生成素的用量。结果共40例完成本研究,静脉组20例,口服组20例,两组患者年龄、性别、族别、维持透析时间、贫血程度、血清铁指标及基因重组红细胞生成素(rHuEPO)用量无显著性差异;治疗8周后贫血均有明显改善,静脉组血红蛋白(Hb)上升(61.45±25.58)%,红细胞压积(Hct)上升(67.22±31.66)%,口服组Hb上升(31.77±13.37)%,Hct上升(34.41±21.81)%,静脉组显著高于口服组(P<0.001);静脉组血清铁蛋白(SF)上升(272.38±502.54)%,口服组上升(186.78±304.55)%,静脉组转铁蛋白饱和度(TSAT)上升(45.6±33.6)%,口服组上升(11.4±12.11)%,静脉组明显高与口服组(P<0.001);静脉组rHuEPO的用量(7150.00±1565.25),口服组rHuEPO的用量(10600.00±2521.49),rHuEPO的用量静脉组低于口服组(P<0.001);治疗8周后两组血清白蛋白升高,静脉组血肌酐下降,其他指标无改变。结论促红细胞生成素联合静脉铁剂治疗肾性贫血的疗效优于口服组,且节省促红细胞生成素的用量,减少治疗费用,适合维持性血液透析(HD)患者铁缺乏的长期补铁的途径。

Intravenous Iron Dextran Treatment of Anemia in Chronic Hemodialysispatients

OBJECTIVE To evaluate the safety and efficiency of intravenous iron dextran in rHuEPO-treated hemodialysis patients.METHODS Forty-four HD patients were randomly dividied into 2 groups,21patients received intravenous iron dextran(IID) and 23 patients received oral iron(OI),8 weeks in total.Levels of serum ferritin(SF),transferrin saturation(TSAT),hemoglobin(Hb),hematocrit(Hct) were tested before and after the treatment.RESULTS At eight weeks,the levers of Hb,Hct,SF and TSAT were all increased in 2 groups,But IID group were significantly higher than OI group(P<0.000).The level of serum albumin were also increase in 2 groups and serum creatine increase in IID group.One case in IID occurred with lower blood pressure and two patients occurred with tetter,Nine patients in OI showed adverse gastrointestinal effects.The rate of side effect in IID(3/21,14.2%) was significantly lower than in OI(9/23,39.1%),P<0.001.CONCLUSION Intravenous iron dextran is better than oral iron in treatment of anemia in chronic hemodialysis,and the incident rate of adverse reaction is lower,So,it can be used for long period to HD patients which is iron deficiency.