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。

Comparison of Effect of Intravenous and Oral Iron Supplementation in Patients with Maintenance Hemodialysis

Objective:To compare the effects of intravenous,oral,and non-iron therapy in patients undergoing maintenance hemodialysis(MHD).Methods:71 MHD patients were enrolled and were randomly divided into intravenous iron group(n=24)and oral iron group(n=27)and non-iron group(n=20).All the patients took r-EPO at the same time.Their red blood cells(RBC),hematocrit(HCT),hemoglobin(Hb),serum ferritin(SF),and transferrin saturation(TAST)were measured before and after administration of the drugs respectively.Results:Eight weeks after the administration,hemoglobin and serum ferritin were significantly higher in the intravenous group than those in the oral group and non-iron group(P<0.01).RBC and Hb of the oral group was significantly higher than that before the administration(P<0.05).Hb and RBC in the control group were showed some improvement with no statistical significance(P>0.05).Eight weeks after the administration,SF and TSAT of the IV group was significantly higher than that before the administration,with SF showing some statistical difference(P<0.01)and TSAT(P>0.05)and when compared with that of the oral and control group,they showed significant difference(P<0.01),but SF and TSAT of the two groups showed no significant difference before and after the administration(P>0.05).Conclusion:Patients with MHD have different levels of iron deficiency.Intravenous and oral supplementation combined with r-EPO can effectively improve anemia and iron deficiency with better results than that of oral administration.