University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland.
Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
Swiss Med Wkly. 2024 Jul 24;154:3771. doi: 10.57187/s.3771.
Bariatric surgery induces several micronutrient deficiencies that require supplementation. For iron, parenteral infusions are usually preferred over oral supplementation. Ferric carboxymaltose infusion has been associated with hypophosphataemia, mostly transient and asymptomatic. However, in some cases, ferric carboxymaltose-induced hypophosphataemia may persist for weeks to months and may induce muscle weakness, osteomalacia and bone fractures. The aim of this study was to identify possible predictors of a clinically relevant decrease in serum phosphate after ferric carboxymaltose infusion in patients with previous Roux-en-Y gastric bypass.
Patients with previous Roux-en-Y gastric bypass who received ferric carboxymaltose infusions between January 2018 and September 2019 and had recorded phosphataemia before and after ferric carboxymaltose infusion at the Lausanne University Hospital, Lausanne, Switzerland, were studied retrospectively. A multiple linear regression model was built with delta phosphataemia as the outcome to investigate the factors related to magnitude of serum phosphate lowering.
Seventy-seven patients (70 females and 7 males) with previous Roux-en-Y gastric bypass were studied. Mean age (SD) was 43.2 (10.7) years and median BMI was 30.9 kg/m2 (IQR 27.9-36.4). Sixty-eight patients (88.3%) received an infusion of 500 mg ferric carboxymaltose and 9 patients (11.7%) received 250 mg ferric carboxymaltose. Forty-nine patients (63.6%) developed hypophosphataemia (<0.8 mmol/l) after ferric carboxymaltose infusion. Median plasma phosphate significantly decreased by 0.33 mmol/l (IQR 0.14-0.49) (p<0.0001). Multiple linear regression identified the ferric carboxymaltose dose as the only risk factor significantly associated with the magnitude of serum phosphate lowering, with an additional mean loss of 0.26 mmol/l with a 500 mg infusion compared to a 250 mg infusion (p = 0.020).
Ferric carboxymaltose infusions substantially decreased plasma phosphate levels in patients with previous Roux-en-Y gastric bypass. Compared to a dose of 250 mg, infusion of a dose of 500 mg ferric carboxymaltose decreased the plasma phosphate further in this population.
减重手术会引起多种微量营养素缺乏，需要补充。对于铁，通常首选肠外输注而非口服补充。羧基麦芽糖铁输注与低磷血症有关，大多为短暂且无症状。然而，在某些情况下，羧基麦芽糖铁引起的低磷血症可能持续数周至数月，并可能导致肌肉无力、骨软化症和骨折。本研究的目的是确定在瑞士洛桑大学医院接受羧基麦芽糖铁输注的既往 Roux-en-Y 胃旁路术患者中，铁羧基麦芽糖输注后血清磷酸盐临床显著下降的可能预测因素。
对 2018 年 1 月至 2019 年 9 月期间在瑞士洛桑大学医院接受羧基麦芽糖铁输注且输注前后记录有血清磷酸盐值的既往 Roux-en-Y 胃旁路术患者进行回顾性研究。使用 delta phosphataemia 作为因变量建立多元线性回归模型，以探讨与血清磷酸盐降低幅度相关的因素。
共纳入 77 例既往 Roux-en-Y 胃旁路术患者（70 名女性和 7 名男性）。平均年龄（标准差）为 43.2（10.7）岁，中位数 BMI 为 30.9 kg/m2（IQR 27.9-36.4）。68 例（88.3%）患者输注 500mg 羧基麦芽糖铁，9 例（11.7%）患者输注 250mg 羧基麦芽糖铁。49 例（63.6%）患者在输注羧基麦芽糖铁后出现低磷血症（<0.8mmol/L）。中位血浆磷酸盐显著下降 0.33mmol/L（IQR 0.14-0.49）（p<0.0001）。多元线性回归确定羧基麦芽糖铁剂量是唯一与血清磷酸盐降低幅度显著相关的危险因素，与输注 250mg 相比，输注 500mg 时血清磷酸盐平均额外降低 0.26mmol/L（p=0.020）。
羧基麦芽糖铁输注显著降低既往 Roux-en-Y 胃旁路术患者的血浆磷酸盐水平。与 250mg 剂量相比，在该人群中输注 500mg 剂量的羧基麦芽糖铁进一步降低了血浆磷酸盐水平。
