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Ngokolingo olungenamkhethe lwaseYurophu, unyango lwangoku lokubuyisela intsimbi kwi-intravenous lubangele izehlo eziphezulu kakhulu ze-hypophosphatemia kwizigulana ezine-anemia ezinxulumene nesifo samathumbu (IBD), ngaphandle kwefuthe elithelekisekayo kwi-hemoglobin kunye neevenkile zentsimbi.
UHeinz Zoller, MD, unika ingxelo yokuba kuphononongo lwe-PHOSPHARE-IBD ​​lwezigulana ezingama-97 ze-IBD ezine-anemia yokunqongophala kwentsimbi ecwangciselwe i-iron carboxymaltose (FCM; Injectafer) ngokuchasene ne-iron demethylmaltose (FDI; Monoferric).phezulu kwizigulane., IYunivesithi yezoNyango yase-Innsbruck, e-Austria, kunye nabalingane.
Ukususela kwisiseko ukuya kumhla we-35, i-51% yezigulane ze-FCM kunye ne-8.3% yezigulane ze-FDI zine-hypophosphatemia nangaliphi na ixesha, njengoko kubonakaliswe ngamanqanaba e-serum phosphate ngaphantsi kwe-2.0 mg / dL (ingozi ehlengahlengisiweyo yomngcipheko - 42.8, 95% CI -57.1 ukuya -24.6 )., P<0,0001), — написала группа в Gut. , P <0.0001), iqela labhala kwiGut.
Abaphandi basebenzise iidosi ezifanayo ezisekwe kwi-hemoglobin kunye nobunzima bomzimba kuzo zombini iimveliso ukukhupha izinto ezinokuthi zibhideke kwizilingo zangaphambili. Isiganeko esiphezulu se-hypophosphatemia senzeke kwiiveki zokuqala ze-2 zokunyuswa, kwaye zahlala ziphakamileyo kwiqela le-FCM kwiintsuku ze-70 (59.2% vs 12.5%, P <0.0001). Isiganeko esiphezulu se-hypophosphatemia senzeke kwiiveki zokuqala ze-2 zokunyuswa, kwaye zahlala ziphakamileyo kwiqela le-FCM kwiintsuku ze-70 (59.2% vs 12.5%, P <0.0001). Самая высокая частота гипофосфатемии возникла в течение первых 2 Недель инфузии и оставалась повышенной в групенге 70,0,0% 70,0,0,2% FCM5,0,2,2,20,00,20,00,20,20,20,20,20,70,2000, 1,000, 20, 10, 10, 1, 1, 1,,,,,,,,. Isiganeko esiphezulu se-hypophosphatemia senzeke kwiiveki zokuqala ze-2 zokunyuswa kwaye zahlala ziphakamileyo kwiqela le-FCM emva kweentsuku ze-70 (59.2% vs 12.5%, P<0.0001).低磷血症的最高发生率发生在输注的前2 周内，并且在FCM 组在70 天时仍然升高（59.05% vs 12.低磷血症的最高发生率发生在输注的前2 周内，并且在FCM 组在70 天时仍然升高（59.00% vs 12.0% Самая высокая частота гипофосфатемии возникла в течение первых 2 Недель инфузии и оставалась повышенной в тегений 1,п5, песни 70,п5, песни 70,п5, пер. Isiganeko esiphezulu se-hypophosphatemia senzeke kwiiveki zokuqala ze-2 zokunyuswa kwaye zahlala ziphakamileyo iintsuku ze-70 kwiqela le-FCM (59.2% vs 12.5%, P <0.0001).
"Ngaphandle kokusebenza okufanayo kwaye akukho mahluko ekuphenduleni kwe-allergies, ezibini ezixhaphakileyo zisetyenziselwa amalungiselelo esinyithi e-intravenous e-Europe zineprofayili ecacileyo yokhuseleko, njengoko i-iron desmethylmaltose inokuthathwa njengento ekhuselekileyo," uZoller uxelele iMedPage Namhlanje.
Ukunqongophala kwe-iron anemia yingxaki eqhelekileyo yangaphandle kwe-IBD enokuphazamisa umsebenzi womzimba kunye nengqondo kunye nokwandisa umngcipheko wokulaliswa esibhedlele.Njengoko kukhankanyiwe ngaphambili, i-FCM kunye ne-FDI ibonise ukusebenza ngokulinganayo ekulungiseni ukusilela kwe-anemia ye-iron kunye nokunyuka okufanayo kwe-hemoglobin emva kweentsuku ze-70 (25.2 kunye ne-24.9 g / l, ngokulandelanayo).
Umahluko kwizehlo ze-hypophosphatemia phakathi kwamachiza amabini okubuyisela intsimbi abonwe ngaphambili aye achazwa ngokuyinxenye bubungqongqo okanye i-etiology yokunqongophala kwentsimbi, umsebenzi osisiseko wezintso wezigulane, kunye neerejimeni zedosi ezahlukeneyo zamachiza afakwa emithanjeni..Ulingo lwangaphambili olungenamkhethe oluthelekisa iindlela ezimbini zonyango zokutshintshwa kwentsimbi, ulingo lwase-US PHOSPHARE-IDA, lukwabonise izehlo eziphezulu ze-hypophosphatemia kwi-FCM, nangona idosi kunye neeshedyuli zedosi zahluka ngokolwazi olufanelekileyo oluvunyiweyo lwe-FDA.
"Uphononongo lwangoku lubonise ukuba, nangona ukubuyisela kwi-hypophosphatemia, ikhosi ye-cascade yotshintsho lwe-biochemical ehambelana nokubonakaliswa okuphezulu kwe-FGF23 [i-fibroblast factor factor 23], ebizwa ngokuba yi-"6H syndrome", izimele kwizigulane ezifumana i-FCM," uZoller.kunye noogxa babhala.
"Ngokukodwa, i-bone-specific [alkaline phosphatase] yahlala iphakamileyo kwiqela le-FCM xa kuthelekiswa neqela le-FDI ngosuku lwe-70, oku kuthetha ukuba i-FCM ichaphazele ukuguqulwa kwamathambo kulo lonke uvavanyo nangaphezulu," baqhubeka."Esi siphumo sinokudibanisa i-hypophosphatemia kunye ne-osteomalacia, ingxaki ekhulayo ye-FCM esandula kudweliswa njengesilumkiso esikhethekileyo kulwazi lwaseYurophu kwizigulana ezine-FCM."
UZoller uxelele iMedPage Namhlanje ukuba uphando olongezelelekileyo "lujolise ekuqondeni ukuba kutheni la machiza mabini ahluka ekufakweni kwawo kwe-FGF23, ihomoni ebangela impendulo entsonkothileyo ekhokelela kwi-hypophosphatemia, ukunqanda ukukhula kweziyobisi kwixesha elizayo."Ukuze ube nesi siphumo kwaye uqonde lo mthetho. ”.”
I-PHOSPHARE-IBD ​​​​luvavanyo oluyimfama oluphindwe kabini, olungenamkhethe lwezigulane ezingama-97 ze-IBD - i-61% ene-ulcerative colitis (UC) kunye ne-39% nge-Crohn's disease (CD) - kwizibhedlele ezingama-20 zaseYurophu ukususela ngo-2018. 2020.
Izigulane ezifanelekileyo zifuna i-serum ferritin level ye-100 ng / mL okanye ephantsi, inqanaba le-hemoglobin elingaphantsi kwe-130 g / L, kwaye lifuna ukuxhaswa kwentsimbi ngokukhawuleza okanye ukunyanzeliswa kwentsimbi yomlomo / ukungabi namdla, phakathi kwezinye iindlela.
Abathathi-nxaxheba bahlelwe ngokungaqhelekanga kwi-1: umlinganiselo we-1 wokufumana umthamo ofanayo we-FDI okanye i-FCM esekelwe kwi-hemoglobin kunye nobunzima bomzimba kwisiseko kunye neentsuku ze-35 kamva.Kwizigulane ezinamazinga e-hemoglobin angaphantsi kwe-100 g / l, i-dose iyonke yi-1500 mg kwizigulane ezinobunzima obungaphantsi kwe-70 kg kunye ne-2000 mg kwizigulane ezinobunzima be-70 kg okanye ngaphezulu.Izigulane ezinezinga le-hemoglobin ye-100 g / l nangaphezulu zafumana umthamo opheleleyo we-1500 mg.
UZoller kunye noogxa bakhe babhala: "Ngenxa yoyilo lophononongo, kunokugqitywa ukuba umahluko obonwayo kwizehlo ze-hypophosphatemia ngokupheleleyo kungenxa yomahluko kumalungiselelo esinyithi, kwaye hayi kwidosi iyonke yentsimbi, irejimeni yokudosa, umahluko kwiCD. xa kuthelekiswa ne-UC.okanye ezinye izinto ezinxulumene nesigulane ezifana nokusebenza kwezintso, ubunzima bokuvuvukala, iqondo lokunqongophala kwentsimbi, okanye ukungabikho kwe-vitamin D. "
Iminyaka yobudala yezigulane kwisifundo yayiyiminyaka eyi-42, i-53% yayingabasetyhini, ininzi yayimhlophe (86%), kwaye i-index mass mass index yayingu-27.6.Inqanaba eliqhelekileyo le-hemoglobin kwinqanaba lokuqala laliyi-105 g / l.
Ukuphindaphinda kweziganeko ezimbi (AEs) kunye neziganeko ezimbi kakhulu (AEs) zazifana neemveliso ezahlukeneyo, kodwa ezininzi zazo zincinci (80-83%).Iqela le-FCM lalinokungabikho kwe-vitamin D (35% vs 23%) kunye neemeko ezininzi ze-nasopharyngitis (20% vs 17%) kuneqela le-FDI.Kwiqela le-FDI, intloko (i-19% vs. 10%) yayixhaphake kakhulu, njengoko yayiyi-nausea (13% vs. 2%).Izigulane ezininzi kwiqela le-FDI ziye zayeka unyango ngenxa yee-AEs (6% vs 2%).
Nangona zombini ukungenelela kubangele ukuphuculwa kwamanqaku okudinwa kwesigulane, ukuphuculwa okukhulu kunye nokukhawuleza kwabonwa kwiqela le-FDI, nangona lo mahluko ulahlekelwe ukubaluleka emva kweentsuku ze-70.
Ukulinganiselwa kwedatha kubandakanya ixesha elifutshane lokulandelela kunye nokungakwazi ukuvavanya ngokupheleleyo iziphumo zekliniki.
UZaina Hamza nguMedPage umbhali wabasebenzi banamhlanje kwi-gastroenterology kunye nezifo ezithathelwanayo.Uzinze eChicago.
UZoller ubhengeze inkxaso-mali evela ku-Abbvie, Bayer, Falk, Gilead, Merz, Medice, Pierre Fabre, Pharmacosmos, Sanofi kunye neVifor.Ababhali abasebenzisanayo banika ingxelo yobudlelwane kunye neenkampani ezininzi zamayeza kunye nezoshishino.Umbhali-mbhali uphinde wachaza ababhali-bambisene nabo bamalungelo abenzi anxulumene namalungiselelo entsimbi yomzali.
INKCAZELO YOMTHETHO: Zoller H et al."I-Hypophosphatemia emva kokulawulwa kwe-iron desferiomaltose kunye ne-iron carboxymaltose kwizigulane ezine-anemia ye-iron ngenxa yesifo sofuba (i-Phosphare-IBD): uvavanyo lweklinikhi olungahleliwe "Gut 2022;I-DOI: 10.1136/gutjnl-2022-327897.
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