劉素青

【摘要】 目的：比較口服低氧誘導(dǎo)因子（hypoxia - inducible factors，HIF）穩(wěn)定劑與靜脈應(yīng)用蔗糖鐵、右旋糖酐鐵治療腎性貧血的臨床療效和安全性。方法：選取2017年1-12月菏澤市立醫(yī)院腎臟內(nèi)科收治的慢性腎臟病并腎性貧血的患者90例，以治療藥物的不同將口服HIF穩(wěn)定劑的患者30例為A組，靜脈用蔗糖鐵的患者30例為B組，靜脈用右旋糖酐鐵的患者30例為C組。在給予促紅細(xì)胞生成素（EPO）基礎(chǔ)上，持續(xù)治療6周觀察2周，總8周，比較三組患者基本血液學(xué)指標(biāo)[紅細(xì)胞計(jì)數(shù)（RBC）、血紅蛋白（Hb）、網(wǎng)織紅細(xì)胞計(jì)數(shù)（RET）、紅細(xì)胞比容（HCT）]及鐵四項(xiàng)指標(biāo)即[血清鐵（Fe）、血清鐵蛋白（SF）、總鐵結(jié)合力（TS ）及轉(zhuǎn)鐵蛋白飽和度（TSAT）]。觀察三組患者不良反應(yīng)（血糖變化、過敏、胃腸不適、靜脈炎、口腔異味等）發(fā)生情況。結(jié)果：患者臨床療效A組明顯優(yōu)于B、C組。治療前，三組患者血液學(xué)基本指標(biāo)和鐵四項(xiàng)指標(biāo)比較差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）。治療8周后，B、C組比較血液學(xué)指標(biāo)、鐵相關(guān)指標(biāo)比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）;A組與B、C組比較，血液學(xué)指標(biāo)、鐵四項(xiàng)指標(biāo)、EPO劑量比較差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。三組患者不良反應(yīng)中過敏、胃腸不適、靜脈炎、口腔異味比較差異有統(tǒng)計(jì)學(xué)意義（p<0.05）。結(jié)論：口服HIF穩(wěn)定劑與靜脈應(yīng)用蔗糖鐵或右旋糖酐鐵都能有效改善慢性腎臟病并腎性貧血，而口服HIF穩(wěn)定劑能穩(wěn)定血液指標(biāo)、增加總鐵結(jié)合力、降低血清鐵蛋白、減少EPO劑量，安全性較高，不良反應(yīng)少，增加患者依從性。

【關(guān)鍵詞】 低氧誘導(dǎo)因子; 蔗糖鐵; 右旋糖酐; 腎性貧血

【Abstract】 Objective：To compare the clinical efficacy and safety of oral hypoxia-inducing factors（HIF）stabilizers and intravenous use of sucrose iron and dextrin iron in the treatment of renal anemia.Method：From January 2017 to December 2017，90 patients with chronic renal disease and renal anemia were admitted to the Department of Kidney Medicine of Heze City Hospital，they were divided into three groups according the different drugs.30 patients with oral HIF stabilizers as group A，30 patients with intravenous sucrose iron as group B，30 patients with ferric anhydride for venous use as group C.Based on the administration of erythropoietin（EPO），continuous treatment for 6 weeks，observation for 2 weeks，for a total of 8 weeks，the basic hematologic indicators of 3 groups of patients[ Red blood cell count（RBC），hemoglobin（Hb），reticulated red blood cell count（RET），red blood cell specific capacity（HCT）].The four indicators of iron and iron were[ Serum iron（Fe），serum ferritin（SF），total iron binding force（TS）and transferrin saturation（TSAT）] of three groups were compared.The occurrence of adverse reactions（blood pressure changes，allergies，gastrointestinal discomfort，phlebitis，bad breath and so on）of three groups were observed.Result：The clinical curative effect of group A was better than that of group B and group C.There was no significant difference between the basic indexes of hematology and the four indexes of iron（P>0.05）.After 8 weeks of observation，there was no significant difference between B and C groups in hematology and iron correlation（P>0.05）.Compared with group A，B and C，the hematologic indicators，the iron four indicators and EPO dose were statistically significant（P<0.05）.Adverse reactions of allergies，gastrointestinal discomfort，phlebitis and bad breath in three groups were statistically significant（P<0.05）.Conclusion：Oral HIF stabilizers and intravenous use of sucrose iron or dextran iron can effectively improve the blood index of patients with chronic renal disease and renal anemia，while oral HIF stabilizers can stabilize blood index，increase total iron binding force，reduce serum ferritin，and reduce EPO dose.It has higher safety，less adverse reactions，increased patients compliance.