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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2019, Vol. 08 ›› Issue (02) : 67 -72. doi: 10.3877/cma.j.issn.2095-3216.2019.02.004

所属专题： 文献；

论著

静脉补铁与口服补铁治疗非透析慢性肾功能不全患者贫血效果比较的Meta分析
彭晓燕1, 宁小元1, 徐家云1,†()   
  1. 1. 471003　河南科技大学临床医学院，河南科技大学第一附属医院
  • 收稿日期:2018-08-14 出版日期:2019-04-28
  • 通信作者: 徐家云

Meta-analysis of the efficacy of intravenous iron supplementation versus oral iron supplementation on anemia in patients with non-dialysis-dependent chronic kidney disease

Xiaoyan Peng1, Xiaoyuan Ning1, Jiayun Xu1,†()   

  1. 1. The First Affiliated Hospital of The Clinical College of Medicine, Henan University of Science and Technology, Luoyang 471003, Henan Province, China
  • Received:2018-08-14 Published:2019-04-28
  • Corresponding author: Jiayun Xu
  • About author:
    Corresponding author: Xu Jiayun, Email:
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彭晓燕, 宁小元, 徐家云. 静脉补铁与口服补铁治疗非透析慢性肾功能不全患者贫血效果比较的Meta分析[J]. 中华肾病研究电子杂志, 2019, 08(02): 67-72.

Xiaoyan Peng, Xiaoyuan Ning, Jiayun Xu. Meta-analysis of the efficacy of intravenous iron supplementation versus oral iron supplementation on anemia in patients with non-dialysis-dependent chronic kidney disease[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2019, 08(02): 67-72.

目的

通过系统评价评估静脉补铁与口服补铁两种补铁方法对治疗非透析慢性肾功能不全(ND-CKD)患者贫血的疗效。

方法

通过计算机并结合手工检索，检索EMBASE、PUBMED、Cochrane Library，检索时间截止到2017年12月1日，查找所有关于静脉补铁与口服补铁治疗ND-CKD患者贫血疗效的全部外文随机对照试验(RCT)。所得数据采用Rev Man 5.0软件进行Meta分析。

结果

共纳入11项外文RCT研究，合计共1 707例患者，其中静脉补铁852例，口服补铁855例。分析结果示，与口服补铁相比，静脉补铁可显著提高血红蛋白(WMD 0.39 g/dl，95%CI，0.26～0.52；P<0.0001)、转铁蛋白饱和度(TSAT)(WMD 3.97%; 95%CI，2.24～5.7；P<0.0001)及铁蛋白水平(WMD，244.51 ng/ml，95%CI，185.51～303.52; P<0.0001)；两种补铁方法的不良事件发生率无明显差别(RR，0.79; 95%CI，0.44～1.44；P＝0.45)。

结论

通过系统评价得出：与口服补铁相比，静脉补铁对治疗非透析慢性肾功能不全患者的贫血疗效较好。

关键词: 口服铁剂, 静脉补铁, 贫血, 非透析慢性肾功能不全, Meta分析
Objective

To evaluate the efficacy of intravenous iron supplementation versus oral iron supplementation on anemia in patients with non-dialysis-dependent chronic kidney disease (ND-CKD) by the method of systematic evaluation.

Methods

By computer and manual search until December 1, 2017, the EMBASE, PUBMED, and Cochrane Library were searched for all the randomized controlled trials (RCT) on the efficacy of intravenous iron supplementation or oral iron supplementation for anemia patients with ND-CKD. Statistical analyses were conducted with the RevMan Version 5 software for meta-analysis.

Results

A total of 11 foreign language RCT studies were included, totaling 1 707 patients, including 852 cases of intravenous iron supplementation and 855 cases of oral iron supplementation. The results of the analyses showed that the intravenous iron supplementation significantly increased the levels of hemoglobin (WMD 0.39 g/dl, 95%CI 0.26-0.52, P<0.0001), transferrin saturation (TSAT) (WMD 3.97%, 95%CI 2.24-5.7, P<0.0001), and ferritin (WMD, 244.51 ng/ml, 95%CI 185.51-303.52, P<0.0001), compared with oral iron supplementation. There was no significant difference in the incidence of adverse events between the two iron supplementation methods (RR 0.79, 95%CI 0.44-1.44, P=0.45).

Conclusion

The intravenous iron supplementation method was more effective in treating anemia patients with ND-CKD than the oral iron supplementation method.

Key words: Oral iron supplementation, Intravenous iron supplementation, Anemia, Non-dialysis-dependent chronic kidney disease, Meta-analysis
图1 文献检索筛选流程图
表1 本文纳入的11项关于静脉补铁与口服补铁治疗非透析慢性肾功能不全患者贫血疗效的RCT研究
研究名称 研究设计发表国家 静脉补铁(例) 口服补铁(例) 男性(%) 随访时间 血红蛋白(g/dl)/铁蛋白(ng/ml)/转铁蛋白饱和度(%) 铁剂量(mg)
静脉补铁 口服补铁 静脉补铁 口服补铁 静脉补铁 口服补铁
Stoves等(2011)[11] RCT英国 22 23 45.5 65.2 6 m 9.9a/100a/NR 9.7 /74.0a/NR 300/m 200 tid
Aggarwal等(2003)[6] RCT印度 20 20 65.0 80.0 3 m 5.8/181.4/59.8 6.3/190.3/63.3 200/m 200 tid
Charytan等(2005)[12] RCT美国 48 48 39.6 29.2 43 d 9.8/125/16.6 9.7/103.0/15.6 1 000/w 325 tid
VanWyck等(2005)[13] RCT美国 79 82 32.9 31.7 56 d 10.2/92.6/16.4 10.1/103.8/16.7 200×5次/>2 w 325 tid
Agarwal等(2006)[17] RCT美国 36 39 44.4 38.5 70 d 10.5/72.5/17.2 10.7/66.4/17.9 250/w 325 tid
Pisani等(2015)[18] RCT意大利 33 66 30.0 27.0 3 m 10.7/67.7a/7.0 10.8/71.4a/16.5 125/w 30 qd
Qunibi等(2011)[14] RCT美国 147 103 36.1 29.1 56 d 10.1/111.8/15.4 10.0/104.8/15.8 1 000/w 325 tid
Nagaraju等(2013)[15] RCT加拿大 22 18 54.5 72.2 6 m 10.9 67 /16.5a 11.1/71.0a/17.0a 200/m 11 tid
Macdougall等(2014)[16] RCT澳大利亚 153 308 40.5 37.7 12 m 10.3/57.7/16.2 10.4/57.3/15.5 500/w 100 bid
Agarwal等(2015)[17] RCT美国 67 69 74.6 78.3 24 m 10.7/173.0/174.0 10.5/133.0/17.3 200/>2 w 325 tid
Spinowitz等(2006)[19] RCT美国 228 76 41.2 31.6 35 d 9.96/146.1/11.3 9.96/143.5/10.1 1 020/w 200 qd
图2 使用Cochrane风险评估手册对所有研究的风险偏移评估
图4 所有研究及亚洲组、非亚洲组分组研究口服补贴与静脉补铁对转铁蛋白饱和度的影响结果的分析
图5 所有研究及亚洲组、非亚洲组分组研究口服补贴与静脉补铁对铁蛋白的影响结果的分析
图3 所有研究及亚洲组、非亚洲组分组研究口服补贴与静脉补铁对血红蛋白值的影响结果的分析
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