铁缺乏症在接受铁葡聚糖分剂量治疗的脓毒症患者中的表现：一项前瞻性队列研究。

Iron deficiency in sepsis patients managed with divided doses of iron dextran: a prospective cohort study.

机构信息

Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, 40-752, Katowice, Poland.

Transfusion Committee, University Clinical Center of Medical University of Silesia in Katowice, Katowice, Poland.

出版信息

Sci Rep. 2023 Mar 31;13(1):5264. doi: 10.1038/s41598-023-32002-y.

DOI:10.1038/s41598-023-32002-y

PMID:37002279

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10066317/

Abstract

Iron deficiency (ID) impairs hemoglobin (Hb) synthesis and immune function, both crucial for sepsis patients. We assessed the impact of iron dextran on reticulocyte (Ret) Hb equivalent (Ret-He) and Ret subpopulations in iron-deficient sepsis patients. In this prospective clinical study we enrolled patients with sepsis or septic shock with procalcitonin concentration > 0.5 ng/mL, diagnosed with ID based on Ret-He. Study subjects received divided doses of iron dextran until normalization of Ret-He. The study population included 35 subjects. The median Ret-He increase after 2 doses of iron dextran was 3.0 (IQR 1.9-6.1) pg (p < 0.01) with median time to normalization 4 (IQR 3-5) days. Although no change in Ret percentage [Me 1.5 (IQR 1.1-2.1) vs. Me 1.4 (IQR 1.1-2.4) %, p = 0.39] and number [Me 0.05 (IQR 0.04-0.07) vs. Me 0.05 (IQR 0.03-0.06) 10/µL, p = 0.88] was noted, Ret subpopulations changed significantly (p for all < 0.01). Divided doses of iron dextran relatively quickly normalize Ret-He in iron-deficient sepsis patients. Changes in Ret subpopulations suggest increased erythropoietic activity. Further research is needed to explore the role of intravenous iron in this clinical setting.

摘要

缺铁（ID）会损害血红蛋白（Hb）的合成和免疫功能，这对脓毒症患者至关重要。我们评估了右旋糖酐铁对缺铁性脓毒症患者网织红细胞（Ret）血红蛋白当量（Ret-He）和 Ret 亚群的影响。在这项前瞻性临床研究中，我们招募了降钙素原浓度>0.5ng/mL 的脓毒症或脓毒性休克患者，根据 Ret-He 诊断为 ID。研究对象接受右旋糖酐铁分剂量治疗，直至 Ret-He 正常化。研究人群包括 35 名患者。接受 2 剂右旋糖酐铁后，Ret-He 中位数增加 3.0（IQR 1.9-6.1）pg（p<0.01），中位数正常化时间为 4（IQR 3-5）天。虽然 Ret 百分比[中位数 1.5（IQR 1.1-2.1）与中位数 1.4（IQR 1.1-2.4）%，p=0.39]和数量[中位数 0.05（IQR 0.04-0.07）与中位数 0.05（IQR 0.03-0.06）10/µL，p=0.88]无变化，但 Ret 亚群明显变化（p<0.01）。右旋糖酐铁的分剂量治疗可相对较快地使缺铁性脓毒症患者的 Ret-He 正常化。Ret 亚群的变化表明红细胞生成活性增加。需要进一步研究来探讨静脉铁在这种临床情况下的作用。