Venturini Elio, Iannuzzo Gabriella, DI Lorenzo Anna, Cuomo Gianluigi, D'Angelo Andrea, Merone Pasquale, Cudemo Giuseppe, Pacileo Mario, D'Andrea Antonello, Vigorito Carlo, Giallauria Francesco
Cardiac Rehabilitation Unit and Department of Cardiology, Azienda USL Toscana Nord-Ovest, "Cecina Civil Hospital", 57023 - Cecina (LI), Italy.
Department of Clinical Medicine and Surgery, "Federico II" University, 80131 - Naples, Italy.
Int J Cardiol Heart Vasc. 2022 May 2;40:101038. doi: 10.1016/j.ijcha.2022.101038. eCollection 2022 Jun.
Iron deficiency anemia (IDA) is frequent after cardiac surgery and is associated with increased morbidity and mortality. In a retrospective study, we analyzed 106 patients with IDA (hemoglobin [Hb] ≤ 12 g/dl in women and ≤ 13 g/dl in men, transferrin saturation [TSAT] ≤ 20%) on admission to a Cardiac Rehabilitation Unit after cardiac surgery. The patients were divided into two groups, one was treated with oral sucrosomial iron (SI) and the other with intravenous ferric carboxymaltose (FCM). Patients received a single 1000 mg dose of FCM from the day after admission to rehabilitation (T1), or a 120 mg/day dose of SI from T1 until discharge (T2); after discharge, SI was reduced to 30 mg/day until the end of follow-up (T3). Hb was evaluated at T1, T2 and T3; the other hematological parameters at T1 and T3; natriuretic peptides at T1, T2 and T3; 6-minute walk test (6MWT) at T1 and T2. Folate, vitamin B12 and reticulocytes were sampled on admission. Folate deficiency was documented in 60.4% of patients. Hb increased in both groups with no significant differences between the two treatments (p = 0.397). The other iron metabolism parameters (sideremia, transferrin, TSAT) displayed similar behavior, showing a significant increase at T3 (p < 0.001) with both therapies, although the increase was faster with FCM. Ferritin - high on admission - decreased at T3 in the SI group and rose significantly in the FCM group (SI 219.5 vs. FCM 689 ng/ml p < 0.0001). The 6MWT increased significantly at T2, with an overlap between SI and FCM. In conclusion, the results of this study show that SI and FCM exhibit the same effectiveness on IDA; the response time to therapy of both treatments is also equally fast. SI and FCM induce a similar increase in functional capacity. The study shows that SI can be a viable alternative to FCM after cardiac surgery in terms of effectiveness and tolerability.
缺铁性贫血（IDA）在心脏手术后很常见，且与发病率和死亡率增加相关。在一项回顾性研究中，我们分析了106例心脏手术后入住心脏康复科时患有IDA（女性血红蛋白[Hb]≤12g/dl，男性≤13g/dl，转铁蛋白饱和度[TSAT]≤20%）的患者。患者被分为两组，一组接受口服蔗糖铁（SI）治疗，另一组接受静脉注射羧麦芽糖铁（FCM）治疗。患者从入住康复科后的第二天（T1）开始接受单次1000mg剂量的FCM，或从T1开始至出院（T2）接受120mg/天的SI治疗；出院后，SI减至30mg/天直至随访结束（T3）。在T1、T2和T3评估Hb；在T1和T3评估其他血液学参数；在T1、T2和T3评估利钠肽；在T1和T2评估6分钟步行试验（6MWT）。入院时采集叶酸、维生素B12和网织红细胞样本。60.4%的患者记录有叶酸缺乏。两组患者的Hb均升高，两种治疗方法之间无显著差异（p = 0.397）。其他铁代谢参数（血清铁、转铁蛋白、TSAT）表现出相似的变化趋势，两种治疗方法在T3时均显著升高（p < 0.001），尽管FCM升高得更快。铁蛋白——入院时较高——在SI组的T3时降低，在FCM组显著升高（SI 219.5 vs. FCM 689ng/ml，p < 0.0001）。6MWT在T2时显著增加，SI和FCM之间有重叠。总之，本研究结果表明，SI和FCM对IDA的疗效相同；两种治疗方法对治疗的反应时间同样迅速。SI和FCM在功能能力方面诱导相似的增加。该研究表明，就有效性和耐受性而言，SI在心脏手术后可作为FCM的可行替代方案。
