小剂量多频次静脉补铁对维持性血透患者氧化应激的影响

摘要

Objective: To investigate the effect of different intravenous iron treatment regimens on anemia and oxidative stress in maintenance hemodialysis (MHD) patients.rnMethods: A total of 58 MHD patients were randomly divided into a multi-frequency low-dose intravenous iron group (iron sucrose 25 mg, twice a week for 8 weeks, n=19), a less-frequency regular-dose intravenous iron group (iron sucrose 100 mg, once every two weeks for 8 weeks, n=19), and a non-iron group (n=20). Another 20 healthy people served as a control group (n=20). The changes of hemoglobin (Hb), hematocrit (HCT), serum ferritin (SF) and transferrin saturation (TSAT), as well as the oxidative stress parameters of malon-dialdehyde (MDA), superoxide dismutase (SOD) and myeloperoxidase (MPO) were detected before and after the treatment. Results: After 8 weeks, compared with the non-iron group, the levels of Hb, HCT, SF and TSATrn in the two iron groups were significantly elevated (P<0.0l), but there was no difference between the two iron groups (P>0.05). After the single dialysis, the two iron groups had higher level of serum MDA, MPO and lower level of serum SOD than that of the non-iron supplementation group (P<0.0l). The multi-frequency low-dose intravenous iron group had lower level of serum MDA [(5.37 ± 0.73) nmol/mL vs (6.37±1.67) nmol/mL],MPO [(81.41±7.60) U/L vs (96.75± 16.97) U/L] and higher level of serum SOD [(84.77 ± 14.02) U/mL vs (68.23 ± 4.90) U/mL] than that of the less-frequency regular-dose intravenous iron group. After 8 weeks, there was no significant difference between the two iron groups (P>0.05).rnConclusion: Multi-frequency low-dose intravenous iron can effectively improve anemia in MHD patients, whose acute oxidative stress is lower than that of less-frequency regular-dose intravenous iron, and is a relatively safe and effective intravenous iron treatment regimen.%目的:探讨不同静脉补铁方式对维持性血透(MHD)患者贫血和氧化应激的影响.方法:选择MHD患者58例,随机分为3组,小剂量多频次静脉补铁组(蔗糖铁25 mg,每周2次,共8周,n=19)、常规剂量少频次静脉补铁组(蔗糖铁100 mg,每两周1次,共8周,n=19)及不补铁组(n=20),另设健康对照组(n=20).观察各组用药前后血红蛋白(Hb)、红细胞压积(HCT)、血清铁蛋白(SF)、转铁蛋白饱和度(TAST)等疗效指标以及血清丙二醛(MDA)、过氧化物歧化酶(SOD)、髓过氧化物酶(MPO)等氧化应激指标的变化.结果:静脉补铁组患者Hb,HCT,SF,TSAT水平均比用药前升高(P＞0.01),但两组间差异无统计学意义(P＞0.05).与不补铁组比较,静脉补铁组单次血透后血清MDA,MPO值明显增高(p＜0.01),SOD值明显降低(P＜0.01)；常规剂量少频次补铁组较小剂量多频次补铁组单次血透后MDA[(6.37±1.67) nmol/mL vs (5.37±0.73) nmol/mL]和MPO[(96.75±16.97) U/L vs (81.41±7.60) U/L]值增高更明显(p＜0.01),SOD[(68.23±4.90) U/mL vs (84.77±14.02) U/mL]值降低更显著(P＜0.01).治疗8周后,静脉补铁组间MDA,MPO,SOD值比较差异无统计学意义(P＞0.05).结论:小剂量多频次静脉补铁可有效改善MHD患者贫血,增加铁储备,单次诱导的急性氧化应激水平低于常规剂量静脉铁剂,是一种相对安全有效的静脉补铁方式.