Intravenous iron dextran for severe refractory restless legs syndrome.
Intravenous iron dextran for severe refractory restless legs syndrome.
复制标题
静脉注射右旋糖酐铁治疗严重难治性不宁腿综合征。
DOI：
10.1016/j.sleep.2009.12.002
复制
发表时间：
2010
期刊：
影响因子：
4.8
通讯作者：
W. Ondo
中科院分区：
文献类型：
--
作者：
W. Ondo
脑铁减少与不宁腿综合征（RLS）密切相关。口服铁补充剂通常推荐用于RLS，但由于吸收不良和所需剂量的耐受性差，在很大程度上无效。静脉注射铁葡聚糖已被证明可以增加脑铁含量。令人惊讶的是，只有少数报告曾经提出了高剂量静脉铁治疗RLS的临床效果的数据。我们回顾性地确定了25名患者（年龄53.2±11.9,7名男性）接受静脉铁治疗难以常规治疗的RLS。我们在5小时内注射了1g高分子量的右旋糖酐铁。发病年龄为32.6±13.0岁，有RLS家族史的15例。患者在铁治疗前尝试了7.5±2.7种药物治疗RLS。基线铁蛋白范围为5 ~ 248ng/ml（平均43.5±58.0），20/25的铁蛋白低于50。两名受试者由于过敏性症状未完成全部输注，但仍被纳入。总体而言，2名受试者报告所有RLS症状完全改善，11名报告明显改善，2名报告中度改善，3名报告轻度改善，6名报告无改善。对于改善的患者，疗效持续时间变化很大，平均15.8±17.7周，范围1 - 60周。12名受试者进行了多次注射。右旋糖酐铁可以显著改善难治性RLS，但结果不一致，不能由患者人口统计学预测。虽然有较高的过敏反应率，右旋糖酐铁可能优于其他静脉注射铁制剂。
Reduced brain iron is strongly associated with restless legs syndrome (RLS). Oral iron supplements are commonly recommended for RLS but are largely ineffective due to poor absorption and poor tolerability at required doses. Intravenous iron dextran has been shown to increase brain iron content. Surprisingly only a few reports have ever presented data on the clinical effect of high dose intravenous iron for RLS. We retrospectively identified 25 subjects (age 53.2±11.9, 7 male) that received intravenous iron for RLS refractory to conventional treatments. We infused 1g of high molecular weight iron dextran over five hours. The age of RLS onset was 32.6±13.0years and 15 subjects had a positive family history of RLS. Patients attempted 7.5±2.7 medications for RLS prior to iron therapy. Baseline ferritins ranged from 5 to 248ng/ml (mean 43.5±58.0) and 20/25 had ferritins of less than 50. Two subjects did not complete their entire infusion due to anaphylactic type symptoms but are included. Overall, 2 subjects reported complete amelioration of all RLS symptoms, 11 reported marked improvement, 2 moderate improvement, 3 mild improvement, and 6 reported no improvement. For those with improvement, the duration of effect was highly variable, mean 15.8±17.7weeks, range 1–60weeks. Twelve subjects have had multiple infusions. Iron dextran can dramatically improve refractory RLS but results are inconsistent and not predicted by patient demographics. Although burdened by a higher rate of anaphylactic reactions, iron dextran may be superior to other IV iron preparations.