右旋糖酐氢氧化铁治疗肾性贫血的临床研究

目的比较静脉注射右旋糖酐氢氧化铁(科莫非)与口服多糖铁复合物(力蜚能)治疗维持性血液透析患者肾性贫血的疗效与安全性。方法 40例病情稳定的血液透析患者,规律透析2～3次/周。所有患者血红蛋白(Hb)60～100 g/L或红细胞压积(Hct)<30%,血清铁蛋白(SF)<200μg/L,转铁蛋白饱和度(TSAT)<30%,接受皮下注射重组人促红细胞生成素(rHuEPO)每周100～150 U/kg。将上述患者随机分为口服治疗组和静脉治疗组,每组20例,观察期为24周。口服组予多糖铁复合物150 mg/d。静脉组每次透析时静脉滴注右旋糖酐氢氧化铁100 mg,累计1 000 mg后每2周给予维持量100 mg。若患者的Hb达到110 g/L或Hct达到33%以上,则将rHuEPO减量以维持Hb及Hct水平。检测补铁前及补铁4、8、12、24周时患者Hb、Hct、SF以及TSAT水平。结果治疗后两组Hb、Hct、SF、TSAT均较治疗前有明显升高(P<0.05),静脉组Hb、Hct、SF、TSAT上升幅度均高于口服组(P<0.05)。治疗后24周静脉组rHuEPO用量较治疗前及口服组明显减少(P<0.05)。两组治疗前后肝功能差异无统计学意义。治疗后静脉组血清C反应蛋白高于治疗前及口服组,但仍在正常范围内。静脉组不良反应1例,口服组不良反应4例。结论静脉用右旋糖酐氢氧化铁治疗肾性贫血安全有效,不良反应少,且可减少rHuEPO用量。     

右旋糖苷铁与促红细胞生成素治疗肾性贫血

目的：比较静脉补铁与口服补铁对血液透析患者肾性贫血的疗效及不良反应。方法：将50例血液透析伴有肾性贫血的患者，随机分为：①治疗组（静脉补铁组）25例，右旋糖苷铁注射液100mg，每次血液透析中使用，每周2次，共10次。②对照组（口服补铁组）25例。多糖铁胶囊150mg，po qd。观察8周。50例合并使用促红细胞生成素（EPO），每周8000U，sc。观察并比较两组患者治疗贫血的效果、铁代谢指标的变化及不良反应。结果：治疗后，两组患者的Hb、Hct及血清铁蛋白（SP）均较治疗前显著升高（P〈0．01），但治疗组显著高于对照组（P〈0．05）。总有效率分别为88％与65％（P〈0．05），均无不良反应。结论：静脉补铁的疗效明显高于口服补铁。     

静脉注射蔗糖铁和口服铁剂在治疗肾性贫血中的疗效对比研究

目的 24例慢性肾衰竭(CRF)行血液透析患者随机分为两组,12例使用静脉铁剂(蔗糖铁,即森铁能)补充铁剂,12例口服铁剂(琥珀酸亚铁,即速力菲)补充铁剂,同时静脉注射重组人促红细胞生成素注射液(EPO)5000单位,以观察两种方法对纠正缺铁和改善贫血的效果及不良反应。方法口服琥珀酸亚铁治疗组,每次200mg,3次/d,连续8周;静脉注射蔗糖铁治疗组,每次100mg,每周2次,共8周。每2周复查血常规、血清铁,观察治疗前后血红蛋白(Hb)、红细胞比容(Hct)、血清铁蛋白(SF)及转铁蛋白饱和度(TSAT),以及静脉补铁后Hb、Hct、SF、TSAT的动态变化。结果口服补铁组临床有效率20%,胃肠道不良反应明显(8/12,占77.7%),纠正缺铁的维持时间短。静脉补铁组有效率70.9%,不良反应少(胃肠道不良反应1/24,占0.05%;轻度肌肉痛1/24,占0.05%),纠正缺铁的维持时间长。结论 CRF贫血患者静脉补铁优于口服补铁。     

口服与静脉铁剂治疗肾性贫血的疗效比较

目的对慢性肾功衰竭尿毒症患者口服及静脉补铁辅助治疗肾性贫血进行疗效比较。方法选择血液透析患者中病情相对稳定的患者共30人,平均分两组,一组给予口服补充铁剂（维铁缓释片）1片／d,第二组给予静脉补铁（蔗糖铁注射液）每次100mg,每周2次,共9周,依据治疗前后各项指标变化比较两种方法疗效。结果第一组口服补铁有效率18％,并出现明显胃肠道副反应;第二组静脉补铁有效率75％,副作用少。结论慢性肾功衰竭尿毒症肾性贫血的患者静脉补铁优于口服补铁方法。     

口服铁与静脉铁治疗血液透析患者肾性贫血的疗效观察

目的 比较两种补铁方法治疗血液透析患者肾性贫血的疗效与安全性.方法 选择50例血透患者,分为口服组和静脉组.口服组口服琥珀酸亚铁(速力菲)0.2 g,3次/d,静脉组将100 mg蔗糖铁稀释于20 ml 0.9%氯化钠溶液中,于血透时缓慢静脉注射,每周治疗2次,共应用10支,2组均应用5周,分别于治疗前及治疗后复查血红蛋白(Hb)、血清铁(SI)、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)、肝功能,比较2组治疗贫血的疗效及不良反应情况.结果 治疗后2组Hb、Hct、SF及TSAT均较治疗前有明显升高(P＜0.05).结论 2种补铁方案均有效,但静脉补铁血红蛋白上升速度及幅度明显高于口服补铁,且不良反应发生率较口服补铁组无明显差异.     

静脉用蔗糖铁注射液治疗维持性血液透析患者肾性贫血的临床研究

目的比较静脉用蔗糖铁注射液与口服多糖铁复合物对使用促红细胞生成素（EPO）维持性血液透析患者的肾性贫血的疗效与安全性,以减少EPO的用量。方法我院血液净化中心维持性血液透析的贫血患者40例,随机分为静脉组和口服组,各20例。静脉组：蔗糖铁100 mg,在透析开始后2 h,通过透析器静脉端注射至少5 min,每周1次。口服组：口服多糖铁复合物胶囊300 mg,1次/d。总疗程为12周。比较治疗前、后患者的血红蛋白（Hb）、红细胞压积（Hct）、血清铁蛋白（SF）、血清转铁蛋白饱和度（TSAT）、EPO用量及不良反应。结果①治疗前两组年龄、性别比例、体重、EPO用量、Hb、Hct、SF、TSAT水平差异无统计学意义（P〉0.05）。②用药4周时,两组Hb、Hct、SF、TSAT均明显升高（P〈0.05）;治疗4、8、12周时,静脉组Hb、Hct、SF、TSAT升高幅度明显高于口服组,差异有统计学意义（P〈0.05）。③静脉组在用药过程中无不良反应发生,口服组出现消化道不良反应8例。④治疗8、12周时,静脉组应用EPO用量低于治疗前及口服组（P〈0.05）。结论静脉用蔗糖铁可有效纠正维持性透析患者肾性贫血的铁缺乏,改善贫血,安全性好,且能减少EPO用量。     

蔗糖铁治疗维持性血液透析患者肾性贫血疗效观察

目的比较静脉注射蔗糖铁与口服右旋糖酐铁分散片治疗维持性血液透析患者肾性贫血的疗效与安全性。方法将30例病情稳定的血液透析患者随机分为口服组和静脉组,每组各15例,观察期8周。口服组予以右旋糖苷铁分散片150 mg/d;静脉组每次透析时静脉滴注蔗糖铁100 mg,累计1 000 mg后每周给予维持量100 mg。检测补铁前及补铁4、8周时患者血红蛋白(Hbg)、血细胞比容(Hct)、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)等,治疗前和治疗后8周时测C-反应蛋白(CRP)、甲状旁腺激素(PTH)、丙氨酸氨基转移酶(ALT)与天门冬氨酸氨基转移酶(AST)水平等。结果静脉滴注蔗糖铁治疗后患者Hbg、Hct、SF、TSAT均明显升高,而CRP、PTH、ALT、AST均无明显变化。结论静脉滴注蔗糖铁治疗肾性贫血是安全、有效的。     

静脉用蔗糖铁与口服琥珀酸亚铁治疗维持性血液透析肾性贫血患者的临床观察

目的探讨规律血液透析患者不同途径补铁后铁的情况及血红蛋白水平的变化。方法选择60例稳定血透患者,每周透析时间大于等于12h。所有患者血红蛋白（Hb）〈90g／L,大于60g／L,Hct 18％-27％,血清铁蛋白小于300ng／L,转铁蛋白饱和度小于20％,皮下注射促红细胞生成素（EPO）100U·kg^-1·周^-1。将上述患者随机分为两组（口服组和静脉组）,分别采用静脉输注蔗糖铁和琥珀酸亚铁口服,检测治疗前后的血清铁指标和红细胞相关指标。结果静脉补铁及口服补铁均可使Hb,Hct、SF和TSAT升高（P〈0．05）,蔗糖铁组从上升幅度及上升速度明显优于琥珀酸亚铁组（P〈0．05）。结论纠正肾性贫血时静脉应用铁剂安全可靠,疗效优于口服铁剂,并且可以减少EPO用量。     

蔗糖铁治疗肾性贫血的疗效观察

目的观察蔗糖铁治疗肾性贫血的疗效。方法选择慢性肾功能衰竭进行血液透析患者86例,随机分为两组：静脉组和口服组。观察两组患者治疗前后血红蛋白（Hb）、红细胞压积（Hct）、血清铁蛋白（SF）、转铁蛋白饱和度（TSAT）等的变化。结果两组患者在治疗前Hb、Hct、SF、TSAT各项指标均差异无统计学意义（均P〉0．05）。治疗后静脉组的Hb为（98．6±3．5）g／L、Hct为（30．1±2．2）％、SF为（94．8±6．2）μmol／L、TSAr为（19．8±2．6）％,口服组分别为（80．1±3．4）g／L、（27．9±1．4）％、（12．9±3．6）μmol／L、（14．2±2．5）％,静脉组各项指标均较口服组升高明显（均P〈0．05）。两组患者均未见明显不良反应发生亦无过敏反应发生。结论与口服补铁相比,蔗糖铁注射液治疗肾衰竭引起的肾性贫血疗效较好,可有效增加铁储备,是治疗。肾性贫血安全、有效的药物。     

静脉注射与口服铁剂治疗肾性贫血的疗效比较

目的：比较静脉注射铁剂与口服铁剂治疗慢性肾衰竭患者肾性贫血的临床效果。方法：对入选的60例肾性贫血患者以随机抽样法分为2组,每组各30例,在皮下注射基因重组人红细胞生成素（EPO）的基础上,分别采用静脉注射铁剂（静脉组）和口服铁剂（口服组）治疗。静脉组患者给予蔗糖铁静脉滴注,完成总量后,根据患者铁蛋白和血红蛋白（Hb）水平,定期给予100mg维持量。口服组患者口服琥珀酸亚铁200mg,1日3次。以铁剂治疗前后患者Hb和红细胞比容（Hct）的变化等衡量治疗效果。结果：治疗12周后,2组患者Hh、Hct、血清铁（SI）,血清铁蛋白（SF）、转铁蛋白饱和度（TSAT）水平均较治疗前显著升高（P〈0．01）;患者Hb、Hct改变方面,2组比较,差异无统计学意义（P〉0．05）;静脉组患者SF、TSAT上升幅度显著高于口服组（P〈0．01）。结论：静脉组比口服组疗效更好,对于慢性肾衰竭内生肌酐清除率为10～30ml／min的患者,在皮下注射EPO的基础上,联合静脉注射铁剂治疗肾性贫血比口服铁剂更具效果,值得临床推荐。     

儿童缺铁和缺铁性贫血分析

目的：了解我科因病住院的0～14岁患儿缺铁及缺铁性贫血患病情况,指导家长采取预防及治疗措施,减少缺铁性贫血的发病率。方法：抽取2012年1～6月我科住院患儿482名进行血红蛋白、血清铁、不饱和铁及总铁结合力含量测定。结果：调查的482名患儿中缺铁及缺铁性贫血发病率分别为28.0%及13.1%,0～1岁组缺铁41例（33.3%）,缺铁性贫血24例（19.5%）,1～2岁组缺铁57例（40.7%）,缺铁性贫血25例（17.8%）,与2岁以上患儿的缺铁及缺铁性贫血的发病率比较,差异有高度统计意义（P〈0.01）。结论：儿童缺铁及缺铁性贫血发病率较高,需采取综合防治措施以降低发病率。     

铁过载概述及口服祛铁新药地拉罗司

规则输血是维持重度慢性贫血患者生命的重要治疗手段,患者长期依赖输血治疗不可避免地引起体内铁沉积增加。输血相关性铁过载可导致多脏器的损害,特别是沉积在肝脏或心脏,甚至可危及生命。作为传统的铁螯合剂,去铁酮和去铁胺因其不良反应或治疗依从性差等问题无法满足临床治疗需要。地拉罗司是一种新型的口服铁螯合剂,多个II期或III期试验证实其在输血依赖性患者中可获得与去铁胺相似的疗效。近期前瞻性、多中心EPIC研究也证实了其祛铁疗效,且有助于改善地中海贫血患者的心脏铁沉积。本文就铁过载的临床特征、危害性以及祛铁新药地拉罗司对比传统药物的优势做一综述。     

Dependence of intestinal iron absorption on the valency state of iron

Summary 1. In rats iron was absorbed after administration into the gut lumen as ferric iron bound to serum albumin, to nitrilotriacetic acid, and to 8-OH-quinoline sulfonic acid, or as isolated diferri-transferrin. 2. Iron absorption from ⁵⁹Fe-labelled transferrin was inhibited by the addition of rat plasma. 3. The inhibitory component in the rat plasma turned out to be ceruloplasmin (ferrous iron oxidase, EC 1.16.2.1). 4. The absorption of iron from these ferric iron complexes was also inhibited by addition to the incubation medium of ferrozine, a strong anionic Fe(II)-ligand. 5. Uptake and absorptive utilization of transferrin-bound ferric iron was decreased after a prewash of the gut lumen and could be restored by the addition of ascorbate to the incubation medium. 6. The conclusion was drawn from these results that luminal reduction precedes ferric iron absorption and that this is a prerequisite for the uptake into the mucosa. Send offprint requests to P. Wollenberg     

蔗糖铁注射液治疗缺铁性贫血临床观察

目的：探讨静脉用蔗糖铁治疗缺铁性贫血（IDA）的有效性和安全性。方法：选择60例IDA患者。随机分为静脉组和口服药物组,观察两种方法对纠正缺铁、改善贫血的效果和不良反应。结果：治疗后两组患者血红蛋白（Hb）、铁蛋白（Fer）均较治疗前明显升高。静脉组Hb、Fer上升幅度明显高于口服组,差异显著。静脉组无明显不良反应,口服组有12例（20．00％）发生胃肠道反应。结论：静脉用蔗糖铁可作为IDA患者有效治疗方法,疗效优于口服铁剂,且不良反应发生率低。     

Ferric trimaltol corrects iron deficiency anaemia in patients intolerant of iron

Background:

Oral iron supplements, which are usually in the form of ferrous (Fe²⁺) salts, are toxic to the gastrointestinal mucosa, and so intolerance is common, resulting in poor compliance and failure of treatment. The sugar derivative maltol strongly chelates iron, rendering it available for absorption and stabilized in the less toxic ferric (Fe³⁺) form.

Aim:

To test whether ferric trimaltol could correct iron deficiency anaemia in patients intolerant of ferrous sulphate.

Methods:

Twenty-three patients were recruited from gastroenterology clinics, of whom 15 had inflammatory bowel disease, a group often difficult to treat with oral iron. Patients with iron deficiency anaemia and documented intolerance to ferrous sulphate were given 3 months of treatment with ferric trimaltol.

Results:

Nineteen of 23 patients completed the treatment and anaemia was fully corrected in 14 of these, mean haemoglobin increased from 106 ± 15 to 126 ± 16 g/L, and there was a particularly low incidence of side-effects. Of 11 patients with inflammatory bowel disease who completed the study, nine fully corrected their anaemia.

Conclusion:

The results demonstrate that in patients intolerant of ferrous compounds, ferric trimaltol corrects iron deficiency and has a low incidence of side-effects.

     

Importance of iron and iron metabolism in nonalcoholic fatty liver disease

Iron homeostasis disturbances are associated with liver disease. Non-alcoholic steatohepatitis is part of the spectrum of non-alcoholic fatty liver disease, which can progress to hepatic cirrhosis and end-stage liver disease. Increasing information supports that multiple factors underlie the development and progression of nonalcoholic steatohepatitis. However, the relation between non-alcoholic steatohepatitis and iron metabolism/ overload is still controversial. We review the recent literature, both basic and clinical, regarding iron homeostasis as it pertains to the pathogenesis of nonalcoholic fatty liver disease.     

Therapeutic potential of iron chelators in diseases associated with iron mismanagement

A considerable array of diseases are now recognized to be associated with misplacement of iron. Excessive deposits of the metal in sensitive tissue sites can result in formation of destructive hydroxyl radicals as well as in stimulation of growth of neoplastic and microbial cell invaders. To counteract potential iron damage, hosts employ the iron chelators, transferrin and lactoferrin. These proteins have been recently developed into pharmaceutical products. Additionally, a variety of low molecular mass iron chelators are being used/tested to treat whole body iron loading, and specific diseases for which the metal is a known or suspected risk factor.     

Cancer-cell-specific cytotoxicity of non-oxidized iron elements in iron core-gold shell NPs

Gold-coated iron nanoparticles (NPs) selectively and significantly (P <0.0001) inhibit proliferation of oral- and colorectal-cancer cells in vitro at doses as low as 5 μg/mL, but have little adverse effect on normal healthy control cells. The particle treatment caused delay in cell-cycle progression, especially in the S-phase. There was no significant difference in the NP uptake between cancer and control cells, and cytotoxicity resulted primarily from the iron core, before oxidation, rather than from the Fe ions released from the core. In contrast with magnetic NPs that usually serve as drug carriers, diagnostic probes or hyperthermia media, the iron, before oxidation, in the NPs selectively suppressed cancer cell growth and left healthy control cells unaffected in vitro and in vivo. This novel nanomaterial holds great promise as a therapeutic tool in nanomedicine. FROM THE CLINICAL EDITOR: Gold-coated iron nanoparticles (NPs) selectively suppressed squamous cell carcinoma (SCC) and colorectal cancer (CRC) cell growth, but left healthy control cells unaffected both in vitro and in vivo. The particles were equally uptaken by all cells, but delayed cell progression only for cancer cells. The origin is related to the iron core: neither iron ions nor the oxidized NPs have the same outcome.     

Stimulation of iron uptake and Hb synthesis in iron deficient reticulocytes

The effect of inhibitors and intermediates of heme synthesis, inhibitor of globin synthesis, and some iron proteins on in vitro iron uptake and haemoglobin synthesis by reticulocytes of iron deficient subjects was investigated in this study. Lead, INH, ALA, mesoprophyrin, ferritin and albumin substantially increased iron uptake by iron deficient reticulocytes, while cycloheximide and glycine depressed it. The results showed that it is possible to stimulate iron uptake and Hb synthesis in iron deficiency by substances other than iron; the most effective and remarkable of them was ferritin.