【作者】 唐静；

【导师】 钟慧； 付平；

【作者基本信息】 四川大学 ， 内科学（肾内）（专业学位）， 2021， 硕士

【摘要】 目的:探讨小剂量连续静脉补铁在腹膜透析患者贫血治疗中的疗效及安全性。方法:选取行腹膜透析的缺铁性贫血患者62人,根据患者意愿分为口服补铁组及静脉补铁组。口服组:给予多糖铁复合物300mg每天1次口服,连续6个月;静脉组:蔗糖铁注射液200mg静滴,连续3天。比较两组治疗前后贫血、铁代谢指标、肾功能、炎症及其他指标变化情况。结果:治疗1月后,静脉组血红蛋白(HGB)、红细胞压积(HCT)明显升高,静脉组血清铁(Fe)、铁蛋白(FER)及转铁蛋白饱和度(TSAT)也明显增加。改善贫血疗效方面:静脉组血红蛋白平均升高16.81±10.00g/L,优于口服组11.25±10.07g/L,静脉组纠正贫血显效率70.97%,有效率96.77%,明显优于口服组(32.25%,90.32%),差异有统计学意义(p=0.03);改善缺铁方面:静脉组铁蛋白增加188.3(96.3,280.8)μg/L,明显优于口服组26.2(0,40.6)μg/L,静脉组纠正缺铁有效率83.9%,明显优于口服组16.1%(p<0.001)。静脉组治疗1月后高敏C反应蛋白(Hs-CRP)、白介素6(IL-6)较治疗前轻度升高,但未额外增加患者感染发生率。静脉组及口服组治疗1月后尿量均较前减少,虽仅静脉组治疗前后差异有统计学意义,但两组患者尿量减少差值差异无统计学意义。有尿患者治疗1月后胱抑素-C(Cys-C)均较前升高,CysC-RRF、残肾GFR(D)、残肾kt/v、残肾Ccr较治疗前均降低。但两组患者肾功能指标下降值差异均无统计学意义。治疗6月后两组HGB、Fe水平与治疗后1月均无差异。尽管FER较治疗后1月口服组增加,静脉组下降,但静脉组仍高于口服组,且高于治疗前。两组患者耐受性及依从性均较好,无不良反应发生。结论:口服及小剂量静脉补铁方式均能改善患者贫血状态,但小剂量静脉补铁方法更优,并可显著改善患者缺铁状态。小剂量静脉补铁没有明显降低患者残余肾功能,不增加患者感染发生率。对口服铁效果不好或不愿接受口服者,小剂量静脉补铁是可用于腹膜透析患者的一种有效、安全且实用的补铁方式。更多还原

【Abstract】 Objective:To investigate the efficacy and safety of low-dose continuous intravenous(IV)iron sucrose supplementation of renal anemia in peritoneal dialysis(PD)patient.Method:Sixty-two peritoneal dialysis patients diagnosed with iron deficiency anemia were selected and divided into oral iron supplement group or intravenous iron supplement group depended on their wishes.Oral group:applied with polysaccharide iron complex 300mg once a day for consecutive 6 month;Intravenous group:intravenously injected with iron sucrose 200mg for 3 consecutive days.Anemia,iron metabolism indexes and clinical efficacy were compared between those two groups.Result:Baseline hemoglobin,mean corpuscular volume,iron metabolism index for both groups were comparable.In addition to the improved hemoglobin(HGB)and hematocrit(HCT),the serum iron(Fe),serum ferritin(FER)and transferrin saturation(TSAT)were significantly increased in intravenous group after one month treatment.The increase of hemoglobin(16.81±10.00g/L VS.11.25±10.07g/L).The significant efficiency and effective rate in the intravenous group were 70.97%and 96.77%,which were significantly better than that in the oral group(32.25%,90.32%)(P=0.03).It was shown that the ferritin and treatment efficiency were remarkably increased in intravenous group when compared with that of oral treatment.After 1 month of treatment,Hs-CRP and IL-6 was slightly higher in the intravenous group without increased infection incidence.The urine volume decreased following one month treatment in both groups.Despite significantly decreased the urine volume after intravenous treatment,no difference of this index was found in those patients.Contrast to increased cystin-C,Cysc-RRF,GFR(D),KT/V and Ccr were decreased in those patients after iron treatment,but no difference of those index was found.Compared with 1 month after treatment,FER increased in the oral group and decreased in the intravenous group after 6 months,but it was still higher than before treatmenti n the intravenous group.Patients in both groups had good tolerance and compliance,and no adverse reactions occurred.Conclusion:It was shown that both oral and low-dose intravenous iron treatment can improve the anemia status,and low-dose intravenous iron supplementation further improved iron deficiency status.The obtained results indicated that low-dose intravenous iron treatment had on effects on the residual renal function and yet increase the incidence of infection.In conclusion,low-dose intravenous iron supplementation is an effective and safety method for anemia treatment in peritoneal dialysis patients,especially for those who had few effects or rejected to oral iron treatment.更多还原