Iron Replacement in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.
Iron Replacement in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.
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DOI：
10.1097/mib.0000000000000386
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发表时间：
2015-08
影响因子：
4.9
通讯作者：
Moss AC
中科院分区：
文献类型：
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作者：
Abhyankar A;Moss AC
许多对照试验和前瞻性研究比较了静脉注射 (IV) 铁剂和口服 (PO) 铁剂治疗 IDA 的效果，结果好坏参半。我们对 2014 年发表的试验进行了系统回顾，这些试验比较了静脉注射铁剂和口服铁剂治疗 IBD 患者缺铁的效果。进行荟萃分析以生成效果估计。还根据 GRADE 标准进行质量评估。五项研究符合我们的纳入标准，招募了 694 名患者。对于“缓解”这一主要结局（血红蛋白升高>2g/dl），IV铁剂或PO铁剂之间没有显着差异；静脉注射缓解的风险比 (RR) 为 1.08（95% CI 0.9, 1.2，p=0.2）。对于 Hb 平均变化 (g/dl) 的次要结果，PO 和 IV 铁剂之间的平均差异不具有统计学显着性（平均差异 0.6g/dL，96% CI -0.1, 1.3，p=0.08）。与 PO 铁相比，IV 铁与血清铁蛋白初始升高显着相关（平均差 89ng/ml，95% CI 29, 148，p=0.003）。在这些试验中，与 PO 铁剂相比，IV 铁剂队列中因不良事件而退出的风险较低（RR 0.4，95% CI 0.1、1.0，p=0.05）。在这项荟萃分析中，我们发现静脉补铁和口服补铁在纠正 IBD 患者缺铁性贫血方面没有显着差异。与接受 PO 铁剂的患者相比，接受 IV 铁剂治疗的患者血清铁蛋白升高幅度更大，并且因不良事件而停止治疗的可能性较小。
A number of controlled trials and prospective studies have compared intravenous (IV) to oral (PO) iron for the treatment of IDA, with mixed results. We conducted a systematic review of trials published to 2014 that compared IV to PO iron to treat iron deficiency in patients with IBD. Meta-analysis was performed to generate effect estimates. Quality assessment was also performed according to GRADE criteria. Five studies met our inclusion criteria, enrolling 694 patients. For the primary outcome of ‘response’ (Hb rise >2g/dl), there was no significant difference between IV or PO iron; risk ratio (RR) for response with IV was 1.08 (95% CI 0.9, 1.2, p=0.2). For the secondary outcome of mean change in Hb (g/dl), the mean difference between PO and IV iron was not statistically significant (mean difference 0.6g/dL, 96% CI −0.1, 1.3, p=0.08). IV iron was associated with a significantly greater initial rise in serum ferritin compared to PO iron (mean difference 89ng/ml, 95% CI 29, 148, p=0.003). There was a lower risk of withdrawal due to adverse events in these trials in the IV iron cohorts when compared to PO iron (RR 0.4, 95% CI 0.1, 1.0, p=0.05). We found no significant difference between IV and PO iron in correcting iron-deficiency anemia in patients with IBD in this meta-analysis. Patients who received IV iron had a greater rise in serum ferritin, and were less likely to stop treatment due to adverse events, when compared to those who received PO iron.