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Lancet Haematology:缺铁女性如何补铁效果佳?不妨试试这些给药方案

2017-12-26 梁舒瑶 环球医学

2017年发表在《Lancet Haematol》的两项开放性、随机对照试验,比较了缺铁女性中,早晨单剂量法vs每日两次剂量连续vs隔日口服补铁的效果。

2017年发表在《Lancet Haematol》的两项开放性、随机对照试验,比较了缺铁女性中,早晨单剂量法vs每日两次剂量连续vs隔日口服补铁的效果。

背景:目前,治疗铁缺乏症的指南推荐每天分阶段摄入二价铁,以增加铁吸收。然而,每天补铁和分次补铁可能增加血清铁调素,降低随后补铁时的铁吸收。该研究的目的是比较早晨单剂量法vs每日两次剂量连续vs隔日口服补铁的铁吸收情况。

方法:研究者开展了两项前瞻性、开放性、随机对照试验,评价了瑞士ETH苏黎世和苏黎世大学年龄在18至40岁的缺铁女性(血清铁蛋白≤25 μg/L)使用(54Fe)标签、(57Fe)标签或(58Fe)标签的硫酸亚铁。在研究1中,女性被随机分配(1:1)至2个小组。一组连续每天0800 h(±1 h)使用60 mg,为期14天,另一个组隔日使用相同剂量的铁剂,为期28天。在研究2中,女性被分配成2组,按照血清铁蛋白进行分层,保证2组的铁水平相似。一组在0800 h(±1 h)使用铁120 mg,另一组在0800 h(±1 h)和1700 h(±1 h)分2次使用铁60 mg,连续3天。最后一剂后14天,各组互换方案。比较个体间的差异。两项研究的共同主要结局为铁的生物有效性(总和部分铁吸收),通过测量治疗后14天红细胞中同位素丰度,以及血清铁调素来评价。两项研究的入组分配均不设盲,基于意向治疗偏倚进行主要和安全性分析。研究在ClinicalTrials.gov注册,编号NCT02175888(研究1)和NCT02177851(研究2),且完整。

结果:研究1于2015年10月15日~29日纳入40例女性。21例女性被分配至连续治疗组,19例女性被分配至隔日治疗组。在治疗结束(连续治疗组为14天,隔日治疗组为28天)时,连续治疗组的几何平均数(?SD,+SD)累积铁吸收分数为16.3%(9.3,28.8)vs隔天治疗组21.8%(13.7,34.6)(p=0.0013),累积总铁吸收量为131.0 mg(71.4,240.5)vs 175.3 mg(110.3,278.5;p=0.0010)。两组前14天使用补充剂期间,连续治疗组的血清铁调素高于隔日治疗组(p=0.0031)。研究2于2015年8月13日~18日纳入20例女性。10例女性被分配至每天1剂组,10例患者被分配至每天2剂组。两个剂量方案组之间的部分(1至3天几何平均数:11.8%[7.1,19.4]每天1次vs 13.1%[8.2,20.7]每日2次;p=0.33)或总铁吸收(1至3天:44.3 mg[29.4,66.7]每日1次vs 49.4[35.2,69.4]每日2次;p=0.33)没有显着差异。每日2次剂量组的血清铁调素浓度高于每日1次剂量组(p=0.013)。任何研究中均未报告3级或4级不良事件。

阐释:在缺铁女性中,每日两次剂量组增加了血清铁调素浓度,但降低了铁吸收。隔日和单剂量补充铁可以优化铁吸收,或是更可取的给药方案。这些结果应该在缺铁的贫血患者中得到证实。

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    2018-06-18 howi
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    2018-02-18 changfy
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    2017-12-28 fengyi812
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    2017-12-28 kksonne
  7. [GetPortalCommentsPageByObjectIdResponse(id=1829403, encodeId=7a58182940340, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Mon Jun 18 20:42:00 CST 2018, time=2018-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805806, encodeId=377818058064a, content=<a href='/topic/show?id=e976e885830' target=_blank style='color:#2F92EE;'>#给药方案#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78858, encryptionId=e976e885830, topicName=给药方案)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b632500090, createdName=h.y200607_23674418, createdTime=Sun Jan 21 04:42:00 CST 2018, time=2018-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2008328, encodeId=0a942008328db, content=<a href='/topic/show?id=1066844469' target=_blank style='color:#2F92EE;'>#HAE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8444, encryptionId=1066844469, topicName=HAE)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sun Feb 18 03:42:00 CST 2018, time=2018-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1317371, encodeId=7211131e37152, content=<a href='/topic/show?id=74916e0414' target=_blank style='color:#2F92EE;'>#EMA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6704, encryptionId=74916e0414, topicName=EMA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35a460, createdName=fengyi812, createdTime=Thu Dec 28 10:42:00 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1395163, encodeId=b5951395163d1, content=<a href='/topic/show?id=c268e940840' target=_blank style='color:#2F92EE;'>#缺铁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79408, encryptionId=c268e940840, topicName=缺铁)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6eb32500176, createdName=luckyshitiancai_42705684, createdTime=Thu Dec 28 10:42:00 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1499780, encodeId=820e1499e80e2, content=<a href='/topic/show?id=c1e59018895' target=_blank style='color:#2F92EE;'>#补铁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90188, encryptionId=c1e59018895, topicName=补铁)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=97fb9374773, createdName=kksonne, createdTime=Thu Dec 28 10:42:00 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=272763, encodeId=8bfb2e276304, content=好资料学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=92191944782, createdName=thlabcde, createdTime=Tue Dec 26 21:46:43 CST 2017, time=2017-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=272733, encodeId=db1f2e27338e, content=谢谢分享.学习受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Tue Dec 26 20:19:30 CST 2017, time=2017-12-26, status=1, ipAttribution=)]
    2017-12-26 thlabcde

    好资料学习了!

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1829403, encodeId=7a58182940340, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Mon Jun 18 20:42:00 CST 2018, time=2018-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805806, encodeId=377818058064a, content=<a href='/topic/show?id=e976e885830' target=_blank style='color:#2F92EE;'>#给药方案#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78858, encryptionId=e976e885830, topicName=给药方案)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b632500090, createdName=h.y200607_23674418, createdTime=Sun Jan 21 04:42:00 CST 2018, time=2018-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2008328, encodeId=0a942008328db, content=<a href='/topic/show?id=1066844469' target=_blank style='color:#2F92EE;'>#HAE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8444, encryptionId=1066844469, topicName=HAE)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sun Feb 18 03:42:00 CST 2018, time=2018-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1317371, encodeId=7211131e37152, content=<a href='/topic/show?id=74916e0414' target=_blank style='color:#2F92EE;'>#EMA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6704, encryptionId=74916e0414, topicName=EMA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35a460, createdName=fengyi812, createdTime=Thu Dec 28 10:42:00 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1395163, encodeId=b5951395163d1, content=<a href='/topic/show?id=c268e940840' target=_blank style='color:#2F92EE;'>#缺铁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79408, encryptionId=c268e940840, topicName=缺铁)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6eb32500176, createdName=luckyshitiancai_42705684, createdTime=Thu Dec 28 10:42:00 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1499780, encodeId=820e1499e80e2, content=<a href='/topic/show?id=c1e59018895' target=_blank style='color:#2F92EE;'>#补铁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90188, encryptionId=c1e59018895, topicName=补铁)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=97fb9374773, createdName=kksonne, createdTime=Thu Dec 28 10:42:00 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=272763, encodeId=8bfb2e276304, content=好资料学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=92191944782, createdName=thlabcde, createdTime=Tue Dec 26 21:46:43 CST 2017, time=2017-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=272733, encodeId=db1f2e27338e, content=谢谢分享.学习受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Tue Dec 26 20:19:30 CST 2017, time=2017-12-26, status=1, ipAttribution=)]
    2017-12-26 清风拂面

    谢谢分享.学习受益匪浅

    0

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