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右旋糖酐铁可改善终末期肾病的多动腿综合征
“以前其他人的研究结论，加上我们的发现，表明（这些病人）中枢神经系统运动中心的铁运输异常”，第一作者、美国纽约罗彻斯特大学斯朗德（James A. Sloand）告诉路透社记者。他和同事指出，多动腿综合征在终末期肾病患者中较常见，可能与铁缺乏有关。为研究给予右旋糖酐铁是否对病人有帮助，他们进行了一项双盲研究。11位病人被随机分为每天用1000mg右旋糖酐铁，14人用安慰剂。
按照通常的无创生化检查，这些病人没有铁缺乏。但治疗1周后，右旋糖酐铁组的多动腿综合征严重性指数显著改善。2周后效果最大，且改善持续至第4周，然后该指数在两组之间不再有差异。治疗组的血清铁蛋白水平和铁饱和度明显增高，安慰剂组没有。副作用上没有组间差异。
斯朗德总结，这些结论“最终将增加我们对多动腿综合征病因的理解，并有助于我们为长期缓解症状而做的工作”。
A double-blind, placebo-controlled trial of intravenous iron dextran therapy in patients with ESRD and restless legs syndrome.
Sloand JA, Shelly MA, Feigin A, Bernstein P, Monk RD.
Department of Medicine, Nephrology Division, University of Rochester School of Medicine, Rochester, NY, USA. james_sloand@urmc.rochester.edu
BACKGROUND: Restless legs syndrome (RLS) is a common disorder in patients with end-stage renal disease (ESRD) that causes motor agitation and insomnia. Because RLS has been associated with iron deficiency, we sought to investigate the effects of intravenous (IV) iron dextran on symptoms of RLS in a double-blind placebo-controlled trial. METHODS: Patients determined to have RLS by International RLS Study Group criteria were administered either iron dextran, 1,000 mg, or normal saline IV in a blinded fashion. Patient demographic data were collected, and blood chemistry tests, liver function studies, serum iron levels, ferritin levels, and total iron-binding capacity were obtained at baseline and 1, 2, and 4 weeks postinfusion. Side effects or adverse events to interventions were monitored, and RLS symptoms were assessed by a rating scale at the same intervals. RESULTS: Eleven patients were randomly assigned to the administration of iron dextran, and 14 patients to the administration of saline. RLS severity scores were slightly higher in the placebo group at baseline, but hemoglobin levels, iron stores, and other biochemical parameters did not differ. Although no change in symptoms were seen in the placebo-treated group, significant improvement in RLS symptom scores in response to iron dextran was seen 1 week after infusion (-2; interquartile range [IQR], -6 to -1; P = 0.03, Wilcoxon's rank sums), but was greatest at 2 weeks (-3; IQR, -5 to -2 compared with -1 to 0; P = 0.01). Salutary effects of iron persisted at 4 weeks, but were no longer statistically significant. The significant increase in serum ferritin levels and iron saturation observed in the iron dextran-treated group was not seen in the placebo-treated group. No differences in adverse events were noted between groups. CONCLUSION: High-dose iron dextran infusion is associated with a significant, but transient, reduction in symptoms of RLS in patients with ESRD.
Am J Kidney Dis 2004;43:663-670 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-03-27 17:14
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