炎症性肠病的口服和静脉铁剂治疗：血液学反应及生活质量改善
Oral and intravenous iron treatment in inflammatory bowel disease: hematological response and quality of life improvement.
作者信息
Gisbert Javier P, Bermejo Fernando, Pajares Ramón, Pérez-Calle Jose-Lázaro, Rodríguez María, Algaba Alicia, Mancenido Noemí, de la Morena Felipe, Carneros Jose Antonio, McNicholl Adrián G, González-Lama Yago, Maté José
机构信息
Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
出版信息
Inflamm Bowel Dis. 2009 Oct;15(10):1485-91. doi: 10.1002/ibd.20925.
BACKGROUND
The aim was to evaluate the efficacy and tolerance of oral and intravenous iron treatment in anemic inflammatory bowel disease (IBD) patients, considering both hematological and quality-of-life outcomes.
METHODS
We performed a prospective multicenter study in IBD patients with iron deficiency anemia. Patients having hemoglobin >10 g/dL were prescribed oral ferrous sulfate. If hemoglobin <10 g/dL, intravenous (sucrose) iron was administered. Oral iron-intolerant patients were changed to intravenous treatment. Clinical (Truelove/Harvey-Bradshaw), hematological (response defined as hemoglobin normalization), and quality-of-life (shortened CCVEII-9 questionnaire) evaluations were performed at baseline and at 3 and 6 months.
RESULTS
100 IBD patients (59 Crohn's disease, 41 ulcerative colitis) were included. Mean basal hemoglobin levels were 10.8 +/- 1.3 g/dL (range, 6.6-12.9). Seventy-eight patients received oral treatment and 22 intravenous iron. Hemoglobin normalization was achieved in 86% of patients: 89% with oral, and 77% with intravenous iron. An IBD activity increase was not demonstrated in any patient. Four patients (5.1%) showed oral iron intolerance leading to discontinuation of treatment. No adverse events were reported for intravenous iron. Hemoglobin correlated with CCVEII-9 (P < 0.001). The CCVEII-9 score increased in patients who normalized hemoglobin levels in 3 months (from 58 +/- 9 to 73 +/- 10) or 6 months (54 +/- 9, 68 +/- 12, and 74 +/- 10) (P < 0.001).
CONCLUSIONS
Oral iron treatment is effective and well tolerated in most IBD patients, and does not exacerbate the symptoms of the underlying IBD. Intravenous iron, on the other hand, is an effective and safe alternative treatment for iron deficiency anemia in more severely anemic or intolerant patients. Anemia correction with iron treatment is associated with a relevant improvement in the patients' quality of life.
背景
目的是评估口服和静脉注射铁剂治疗贫血性炎症性肠病（IBD）患者的疗效和耐受性，同时考虑血液学和生活质量结果。
方法
我们对缺铁性贫血的IBD患者进行了一项前瞻性多中心研究。血红蛋白>10 g/dL的患者给予口服硫酸亚铁。如果血红蛋白<10 g/dL，则给予静脉注射（蔗糖）铁剂。口服铁剂不耐受的患者改为静脉治疗。在基线、3个月和6个月时进行临床（Truelove/Harvey-Bradshaw）、血液学（血红蛋白正常化定义为反应）和生活质量（缩短的CCVEII-9问卷）评估。
结果
纳入100例IBD患者（59例克罗恩病，41例溃疡性结肠炎）。平均基础血红蛋白水平为10.8±1.3 g/dL（范围6.6-12.9）。78例患者接受口服治疗，22例接受静脉注射铁剂。86%的患者血红蛋白恢复正常：口服铁剂者为89%，静脉注射铁剂者为77%。没有患者出现IBD活动增加。4例患者（5.1%）出现口服铁剂不耐受导致治疗中断。静脉注射铁剂未报告不良事件。血红蛋白与CCVEII-9相关（P<0.001）。血红蛋白水平在3个月（从58±9至73±10）或6个月（54±9、68±12和74±10）恢复正常的患者，CCVEII-9评分升高（P<0.001）。
结论
口服铁剂治疗对大多数IBD患者有效且耐受性良好，不会加重潜在IBD的症状。另一方面，静脉注射铁剂是更严重贫血或不耐受患者缺铁性贫血的一种有效且安全的替代治疗方法。铁剂治疗纠正贫血与患者生活质量的显著改善相关。
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