慢性血液透析患者两种葡萄糖酸铁治疗方式的比较：一项随机试验的结果

Comparison of two iron gluconate treatment modalities in chronic hemodialysis patients: results of a randomized trial.

作者信息

Giordano Antonion, Arrigo Girolamo, Lavarda Fausto, Colasanti Giuliano, Petrini Concetta

机构信息

Division of Nephrology and Dialysis, San Carlo Hospital, Milan, Italy.

出版信息

J Nephrol. 2005 Mar-Apr;18(2):181-7.

PMID:15931646

Abstract

BACKGROUND

Iron supplementation in chronic hemodialyzed patients is not yet completely defined concerning the dosing regimen. This study aimed to evaluate the effects of the same iron load administered in different regimens on anemia, iron status and the reticulocyte (Ret) subpopulation patterns in stable patients on chronic hemodialysis (HD).

PATIENTS AND METHODS

Seventeen patients undergoing thrice-weekly chronic HD and receiving stable alphaerythropoietin therapy with absolute iron deficiency (transferrin saturation (TSAT) <20%, ferritin (Frt) <100 ng/mL) were randomly divided into two groups: group A (n=9) received 20.8 mg of sodium iron gluconate at the end of each dialysis session; group B (n=8) 62.5 mg only at the end of the 1st dialysis session of the week. The treatment period lasted 3 months (period 1) and was followed by 3 months of observation (period 2).

RESULTS

Both treatments increased hemoglobin (Hb) levels by an average of 0.90 g/dL in period 1, with a progressive decline in period 2 (p=ns between groups), peaking at 11.2 g/dL in group A and 10.8 g/dL in group B. The effects on mean red blood cell volume and Hb concentrations were similar. Frt levels more than doubled during period 1 and early in period 2 in both groups (172 microg/L in group A; 149 microg/L in group B, and progressively decreased in period 2 (p=ns between groups). The TSAT index increased progressively peaking to 28.7% in group A and 24.3% in group B. Hypochromic red blood cells (hypocRBC) decreased early from 5.6-2.2% in group A, and from 5.5-2.1% in group B, and persisted in period 2; the between-period differences for the combined groups were statistically significant (p=0.0051). High fluorescence reticulocytes (HFR) increased from period 1 to period 2 only in group B (from 0.8-1.7%, p=0.012).

CONCLUSIONS

Both regimens replenished iron stores and improved anemia. The HFR increase in group B could be due to soluble transferring receptor (STnfR) gene upregulation; alternatively it could indicate the prevalence of immature Ret release from bone marrow.

摘要

背景

关于慢性血液透析患者铁剂补充的给药方案尚未完全明确。本研究旨在评估不同给药方案给予相同铁负荷对慢性血液透析（HD）稳定患者的贫血、铁状态及网织红细胞（Ret）亚群模式的影响。

患者与方法

17例每周进行3次慢性HD且接受稳定的促红细胞生成素治疗且存在绝对铁缺乏（转铁蛋白饱和度（TSAT）<20%，铁蛋白（Frt）<100 ng/mL）的患者被随机分为两组：A组（n = 9）在每次透析结束时给予20.8 mg葡萄糖酸铁钠；B组（n = 8）仅在每周第1次透析结束时给予62.5 mg。治疗期持续3个月（第1阶段），随后观察3个月（第2阶段）。

结果

在第1阶段，两种治疗方法均使血红蛋白（Hb）水平平均升高0.90 g/dL，在第2阶段逐渐下降（组间p值无统计学意义），A组峰值为11.2 g/dL，B组为10.8 g/dL。对平均红细胞体积和Hb浓度的影响相似。两组在第1阶段和第2阶段早期Frt水平均增加了一倍多（A组为172 μg/L；B组为149 μg/L），并在第2阶段逐渐下降（组间p值无统计学意义）。TSAT指数逐渐升高，A组峰值为28.7%，B组为24.3%。低色素红细胞（hypocRBC）在早期从A组的5.6%降至2.2%，从B组的5.5%降至2.1%，并在第2阶段持续存在；联合组不同阶段之间的差异具有统计学意义（p = 0.0051）。仅B组从第1阶段到第2阶段高荧光网织红细胞（HFR）增加（从0.8%增至1.7%，p = 0.012）。