不同静脉铁剂用量对维持性血液透析患者的疗效观察及生存分析

顾铜; 张健美; 李亚光

doi:10.3969/j.issn.1671-2390.2023.07.006

不同静脉铁剂用量对维持性血液透析患者的疗效观察及生存分析

Curative effect and survival analysis of maintenance hemodialysis patients with different intravenous doses of iron

摘要

摘要:
目的观察不同静脉铁剂用量对维持性血液透析（maintenance hemodialysis，MHD）患者的疗效，并分析患者生存情况。
方法选取80例MHD患者（秦皇岛市第一医院于2017年5月至2019年5月收治），采用随机数字表法分为低剂量组（40例）和高剂量组（40例）。其中低剂量组给予100 mg/2周，200 mg/月；高剂量组给予100 mg/周，400 mg/月。比较2组患者氧化应激水平超氧化物歧化酶（superoxide dismutase，SOD）、谷胱甘肽过氧化物酶（glutathione peroxidases，GSH-px），炎症因子水平肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）、白细胞介素6（interleukin-6，IL-6）、超敏C反应蛋白（hypersensitive c-reactive protein，hs-CRP），重组人红细胞生成素（recombinant human erythropoietin，rHuEPO）用量、铁蛋白、血红蛋白水平及不良反应发生情况；绘制生存曲线分析MHD患者使用不同剂量静脉铁剂给药与生存的关系。
结果与治疗前比较，高剂量组和低剂量组治疗后血清SOD（61.68 ± 6.31）U/mL比（120.56 ± 12.16）U/mL和（60.52 ± 6.13）U/mL比（121.34 ± 12.24）U/mL、GSH-px（115.64 ± 11.95）U/L比（180.34 ± 18.11）U/L和（116.23 ± 11.12）U/L比（181.42 ±18.35）U/L水平明显降低（P＜0.05），血清TNF-α（26.74 ± 2.68）ng/L比（15.68 ± 1.58）ng/L和（26.34 ± 2.64）ng/L比（16.11 ± 1.65）ng/L、IL-6（34.67 ± 3.58）ng/L比（23.58 ± 2.41）ng/L和（34.15 ± 3.43）ng/L比（23.69 ± 2.45）ng/L、hs-CRP（3.24 ± 0.90）mg/L比（2.63 ± 0.61）mg/L和（3.13 ± 0.78）mg/L比（2.52 ± 0.59）mg/L水平明显升高（P＜0.05），但组间比较差异无统计学意义（P＞0.05）。高剂量组和低剂量组治疗前后rHuEPO用量（1250.42 ± 125.37）U/W比（1325.67 ± 132.58）U/W、铁蛋白（230.58 ± 22.74）μg/L比（211.46 ± 21.62）μg/L及血红蛋白（3.45 ± 0.56）g/L比（3.78 ± 0.62）g/L变化量比较差异有统计学意义（P＜0.05）；对患者进行为期3年的随访，结果显示，低剂量组有8例患者死亡（20.00%），高剂量组有5例患者死亡（12.50%），绘制K-M曲线行Log-rank检验显示，χ²=0.654，P=0.419。
结论 200 mg/月及400 mg/月静脉铁剂均可加重MHD患者氧化应激及炎症反应，其中400 mg/月静脉铁剂可减少rHuEPO用量，提高铁蛋白及血红蛋白水平，治疗周期短，但对患者3年生存率无明显影响，推荐临床使用。

Abstract:
Objective To explore the efficacy of different doses of intravenous iron on maintenance hemodialysis (MHD) patients and examine the survival status.
Methods Eighty MHD patients were randomized into low-dose group (n=40) and high-dose group ( n=40). Low-dose group received 100 mg/2 weeks for a total of 200 mg per month while high-dose group 100 mg/week for a total of 400 mg per month. The levels of oxidative stress superoxide dismutase (SOD), glutathione peroxidase (GSH-px), inflammatory factors tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), dosage of recombinant human erythropoietin (rHuEPO), ferritin, hemoglobin and occurrence of adverse reactions were compared between two groups. And survival curve was plotted for examining the relationship between different doses of intravenous iron and the survival of MHD patients.
Results Compared with before treatment, the levels of serum SOD (61.68±6.31)U/mL vs (120.56±12.16)U/mL, (60.52±6.13)U/mL vs (121.34±12.24)U/mL, GSH-px (115.64±11.95)U/L vs (180.34±18.11)U/L, (116.23±11.12)U/L vs (181.42±18.35)U/L declined markedly in both groups after treatment (P<0.05); serum levels of TNF-α (26.74±2.68)ng/L vs (15.68±1.58)ng/L, (26.34±2.64)ng/L vs (16.11±1.65)ng/L, IL-6 (34.67±3.58)ng/L vs (23.58±2.41)ng/L, (34.15±3.43)ng/L vs (23.69±2.45)ng/L, hs-CRP (3.24±0.90)mg/L vs (2.63±0.61)mg/L, (3.13±0.78)mg/L vs (2.52±0.59)mg/L spiked greatly (P<0.05). However, inter-group comparison showed no significant difference (P>0.05). Significant inter-group differences existed in rHuEPO dosage (1250.42±125.37)U/W vs (1325.67±132.58)U/W, ferritin (230.58±22.74)μg/L vs (211.46±21.62) μg/L and hemoglobin (3.45±0.56)g/L vs (3.78±0.62)g/L before and after treatment (P<0.05). During a follow-up period of 3 years, 8 deaths (20.00%) occurred in low-dose group while 5 deaths (12.50%) in high-dose group. Kaplan-Meier curve was plotted. Log-rank test indicated that χ²=0.654, P=0.419.
Conclusions Both 200 mg/month and 400 mg/month intravenous iron can aggravate oxidative stress and inflammatory response in MHD patients. And 400 mg/month intravenous iron reduces the dosage of rHuEPO and boosts the levels of ferritin and hemoglobin. With a short treatment cycle, it has no obvious impact on 3-year patient survival. Thus it is recommended for clinical application.

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