Svára F, Sulková S, Kvasnićka J, Polakovic V
Interní oddĕlení VFN a 1. LF UK, Praha--Strahov.
Vnitr Lek. 1996 Dec;42(12):849-52.
The development of secondary anaemia is a constant associated phenomenon of chronic renal failure. During its treatment by recombinant human erythropoietin (rHuEPO) erythropoiesis is accelerated and this increases demands on the supply of dietary erythropoietic precursors (Fe, pyridoxine, folic acid, vitamin B12). In particular as regards iron, frequently the dietary amount is not sufficient and supplementation is necessary. The objective of the present work is to compare oral and intravenous iron supplementation in the treatment of secondary anaemia by rHuEPO in patients with chronic renal failure treated by haemodialysis. A group of haemodialyzed patients (n = 61) treated with erythropoietin, where the serum ferritin concentration had dropped beneath 300 ng/ml, or the transferrin concentration below 0.20 was divided at random into two sub-groups. To group "A" Actiferrin was administered 3 x 1 cps/d (Ferrosi sulfas heptahydricus, corresponding to 34.5 mg elemental Fe and serine 129 mg per capsule, i.e. a total of 724.5 mg elemental Fe per week). To group "A" Ferrum-Lek was administered 1 vial per week by the i.v. route (Ferri oxidum saccharatum, corresponding to 100 mg elemental iron per week). The two groups were comparable as to the mean erythropoietin dose (50 U/kg per week) and the patients' mean age (61 years), the male/female ratio and the spectrum of basic diseases. After six weeks of treatment a comparable increase of the haematocrit and serum iron concentration was observed in both groups. As to transferrin saturation, there was a more marked increment in the intravenously supplemented group. The serum ferritin values in group "A" declined, while in group "F" they increased. After both types of iron supplementation a comparable increase of the haematocrit and serum iron concentration occurred, the iron reserves represented by serum ferritin differed however and from the long-term aspect they are in favour of intravenous iron supplementation in haemodialyzed patients treated with erythropoietin.
继发性贫血的发生是慢性肾衰竭常见的伴随现象。在使用重组人促红细胞生成素（rHuEPO）治疗期间，红细胞生成加速，这增加了对膳食促红细胞生成前体（铁、吡哆醇、叶酸、维生素B12）供应的需求。特别是在铁方面，膳食摄入量常常不足，需要进行补充。本研究的目的是比较口服和静脉补铁在血液透析治疗的慢性肾衰竭患者中使用rHuEPO治疗继发性贫血的效果。一组接受促红细胞生成素治疗的血液透析患者（n = 61），其血清铁蛋白浓度降至300 ng/ml以下，或转铁蛋白浓度低于0.20，被随机分为两个亚组。给“A组”口服Actiferrin，3次/天，每次1粒胶囊（七水硫酸亚铁，每粒胶囊含34.5 mg元素铁和129 mg丝氨酸，即每周共724.5 mg元素铁）。给“F组”每周静脉注射1瓶Ferrum-Lek（含糖氧化铁，相当于每周100 mg元素铁）。两组在促红细胞生成素平均剂量（每周50 U/kg）、患者平均年龄（61岁）、男女比例和基础疾病谱方面具有可比性。治疗六周后，两组的血细胞比容和血清铁浓度均有类似程度的升高。在转铁蛋白饱和度方面，静脉补铁组有更明显的升高。“A组”的血清铁蛋白值下降，而“F组”的血清铁蛋白值升高。两种补铁方式后，血细胞比容和血清铁浓度均有类似程度的升高，但血清铁蛋白所代表的铁储备不同，从长期来看，对于接受促红细胞生成素治疗的血液透析患者，静脉补铁更具优势。
