静脉与口服铁剂比较对维持性血透患者肾性贫血的临床疗效

目的观察慢性肾功能不全患者静脉和口服补铁治疗肾性贫血的疗效、不良反应的发生情况以及对促红细胞生成素(EPO)使用效应的比较。方法病情稳定的48例维持性血透肾性贫血患者,随机的分为静脉组和口服组2组,每组24例,观察期10周。观察用药前、用药后4周、用药后8周、用药后10周的血红蛋白(Hb)、红细胞压积(Hct)、铁蛋白(SF)、不良反应以及应用促红细胞生成素剂量。结果2组患者的血红蛋白、红细胞压积、铁蛋白,治疗后均较治疗前有明显升高,而静脉组升高幅度显著于口服组(P<0.01);2组患者应用促红细胞生成素的剂量在治疗后较治疗前均有所减少,而静脉组减少明显(P<0.05)。结论静脉补铁能及时有效的补充肾性贫血患者所需的铁剂,使贫血状况改善,不良反应少,而且能增强促红细胞生成素效应,减少其用量。

Comparison of the clinical effects of intravenous or oral iron on renal anemia in patients with maintenance hemodialysis effects

Objective To compare the therapeutic effects and adverse reactions between intravenous and oral iron,and the effects of erythropoietin (EPO)in patients with chronic renal failure.Methods Between November,2007 and October,2008,48 patients with renal anemia were randomized into 2 groups:intravenous group and oral group,24 in each.The duration of administration lasted for 10 weeks.All patients received regular EPO,with the dose of 100U·kg~(-1),per week. If the patient's hemoglobin (Hb) was more than 100 g·L~(-1),then the dose of EPO decreased by 50%.If the patient's Hb was more than 120 g·L~(-1),then the dose decreased by 75%.The levels of Hb,hematoerit,serum ferritin,adverse reaction and dose of EPO before and 4 weeks,8 weeks and 10 weeks after the administration were observed.Results The levels of Hb,Hematocrit (Hct)and ferritin(SF)in both groups after administration increased compared with before administration;and there was significant difference between the intravenous group and the oral group(P<0.01).The dosages of EPO in both groups after administration were lower than before administration,whereas the dosage in the intravenous group decreased significantly(P<0.05).In the intravenous group,the adverse reactions were significantly lower and the effect of EPO was significantly higher than in the oral group.Conclusion The intravenous iron can not only supply the iron the patients with renal anemia needed,but also increase the effect of EPO and reduce the dosage of EPO.The adverse reactions of intravenous iron are lower and it is safe and convenient.