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目的:探讨口服铁剂和静脉铁剂对维持性血液透析患者贫血、炎症及氧化应激状态的影响。方法:选择在深圳市福田区人民医院血液净化中心透析龄超过3个月的MHD患者24例,分别给予口服铁剂和静脉铁剂,进行为期8周随访,分别检测治疗前、治疗4周、治疗8周后患者的血红蛋白(hemoglobin,Hb)、红细胞比容(hematocrit,Hct)、血清铁(seruin iron,SI)、铁蛋白(serum fer-ritin,SF)、血清转铁蛋白饱和度(transferrinsaturation,TSAT),C-反应蛋白(C-reactive protein,CRP)、IL-6、TNF-α以及血浆丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、血浆谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)。结果:(1)4周时,A组患者Hb、HCT及铁蛋白均较治疗前升高,差异有统计学意义(P<0.05);8周时,两组Hb、HCT、铁蛋白较治疗前均升高,A组较B组相比显著升高(P<0.05)。A组TSAT较治疗前及B组均显著升高;B组治疗前后TSAT无显著改变;血清铁在A、B两组治疗后无显著改变。(2)CRP、IL-6在口服或静脉补铁期间变化均无显著性(P>0.05),TNF-α在静脉铁剂治疗8周后较前及口服铁剂8周后相比,有显著升高(P<0.05)。(3)4周时,A组患者MDA水平较治疗前及B组均显著上升,SOD、GSH-Px水平显著低于治疗前及B组,其差异有显著性(P<0.05);8周时恢复至治疗前水平。B组治疗过程中未发现MDA、SOD、GSH-Px水平的明显改变。结论:静脉铁剂在改善贫血及缺铁状态的效果优于口服补铁,但短期会诱导炎症及氧化应激反应的加剧。
Objective: To investigate the effects of oral iron and intravenous iron on anemia, inflammation and oxidative stress in maintenance hemodialysis patients. Methods: Twenty-four MHD patients who were dialysised for more than 3 months in the Blood Purification Center of People’s Hospital of Futian District, Shenzhen were enrolled in this study. Oral iron and intravenous iron were given respectively for 8 weeks follow-up. Before treatment and 4 weeks, patients hemoglobin (hemoglobin, Hb), hematocrit (hematocrit, Hct) after 8 weeks of treatment, serum iron (seruin iron, SI), ferritin (serum fer-ritin, SF), serum transferrin saturation (transferrinsaturation , TSAT, C-reactive protein (CRP), IL-6, TNF-α and plasma malondialdehyde (MDA), superoxide dismutase (SOD) Glutathione peroxidase (GSH-Px). Results: (1) Hb, HCT and ferritin in group A were significantly higher than those before treatment at 4 weeks (P <0.05); at 8 weeks, the levels of Hb, HCT and ferritin in group A were significantly higher than those before treatment A group was significantly higher than the B group (P <0.05). TSAT in group A was significantly higher than that before treatment and group B; TSAT had no significant change in group B before and after treatment; serum iron had no significant change in group A and B after treatment. (2) There was no significant difference of CRP and IL-6 in oral or intravenous iron supplementation (P> 0.05). Compared with 8 weeks after intravenous iron treatment, TNF- Significantly increased (P <0.05). (3) At 4 weeks, the level of MDA in group A increased significantly compared with those in group B and the level of SOD and GSH-Px in group A was significantly lower than that before treatment and group B (P <0.05) When restored to pre-treatment levels. No significant changes of MDA, SOD and GSH-Px were found in group B during the treatment. CONCLUSION: Intravenous iron is superior to oral iron in improving anemia and iron deficiency, but it may induce inflammation and increased oxidative stress in the short term.