Seifert A, von Herrath D, Schaefer K
Medizinische Abteilung II, St.-Joseph-Krankenhaus I, Berlin, Germany.
Q J Med. 1987 Dec;65(248):1015-24.
During a 19-month period we determined the incidence of bacterial infection among 39 patients treated with desferrioxamine who had end-stage renal disease and were undergoing maintenance hemodialysis. Twenty-three received desferrioxamine because of aluminum-related bone disease, and 16 because of iron overload. A control group of 193 patients on maintenance hemodialysis but without desferrioxamine was used. No difference was found in the incidence of septicemia or of all bacterial infections between the patients with aluminum-related bone disease treated with desferrioxamine and the control patients (0.12 vs. 0.12 septicemia per patient-therapy-year, p greater than 0.05; 0.23 vs. 0.26 bacterial infections per patient-therapy-year, p greater than 0.05). The incidence of septicemia in patients treated with desferrioxamine for iron overload, however, was almost three times that in the control patients (0.36 vs. 0.12 septicemia per patient-therapy-year, p less than 0.01). To assess the effect of iron overload itself, we determined the frequency of bacterial infection in patients on regular hemodialysis who have never received desferrioxamine. These were subdivided into three groups according to serum ferritin level which indicated normal or low iron stores (Group I: serum ferritin 10-330 micrograms/l, n = 125), moderate (Group II: serum ferritin 331-1000 micrograms/l, n = 49) or more advanced iron overload (Group III: serum ferritin 1001-2000 micrograms/l, n = 10). Compared to patients with normal or low serum ferritin levels (Group I), we found a significantly higher rate of bacterial infection among patients in Group II compared with Group I (0.18 vs. 0.34 infections per patient-therapy-year, p less than 0.05) and Group III compared with Group I (0.18 vs. 0.58 infections per patient-therapy-year, p less than 0.01). These results suggest that treatment with desferrioxamine does not favour the development of septicemia or bacterial infection independently of iron overload and that iron overload itself may predispose patients on regular hemodialysis to bacterial infection.
在19个月的时间里，我们确定了39例接受去铁胺治疗的终末期肾病并接受维持性血液透析患者的细菌感染发生率。23例因铝相关性骨病接受去铁胺治疗，16例因铁过载接受治疗。使用了193例接受维持性血液透析但未使用去铁胺的患者作为对照组。接受去铁胺治疗的铝相关性骨病患者与对照患者之间的败血症或所有细菌感染发生率没有差异（每患者治疗年败血症发生率分别为0.12和0.12，p>0.05；每患者治疗年细菌感染发生率分别为0.23和0.26，p>0.05）。然而，接受去铁胺治疗铁过载的患者败血症发生率几乎是对照患者的三倍（每患者治疗年败血症发生率分别为0.36和0.12，p<0.01）。为了评估铁过载本身的影响，我们确定了从未接受过去铁胺的定期血液透析患者的细菌感染频率。根据血清铁蛋白水平将这些患者分为三组，血清铁蛋白水平表明铁储存正常或低（第一组：血清铁蛋白10 - 330微克/升，n = 125）、中度（第二组：血清铁蛋白331 - 1000微克/升，n = 49）或更严重的铁过载（第三组：血清铁蛋白1001 - 2000微克/升，n = 10）。与血清铁蛋白水平正常或低的患者（第一组）相比，我们发现第二组患者的细菌感染率显著高于第一组（每患者治疗年感染率分别为0.18和0.34，p<0.05），第三组患者的细菌感染率显著高于第一组（每患者治疗年感染率分别为0.18和0.58，p<0.01）。这些结果表明，去铁胺治疗本身并不会促进败血症或细菌感染的发生，与铁过载无关，并且铁过载本身可能使定期血液透析患者易发生细菌感染。
