nodgoРоссийский журнал детской гематологии и онкологии (РЖДГиО)Russian Journal of Pediatric Hematology and Oncology2311-12672413-5496LTD “Graphica”10.17650/2311-1267-2014-0-1-51-61nodgo-14Research ArticleПРОБЛЕМЫ ПРАКТИЧЕСКОЙ ГЕМАТОЛОГИИ-ОНКОЛОГИИPROBLEMS OF PRACTICAL HEMATOLOGY/ONCOLOGYСовременные возможности хелаторной терапииCurrent possibilities of chelation therapyСметанинаНаталия СергеевнаSmetaninaN. S.

Москва

Moscow

nataliya.smetanina@fnkc.ruФГБУ ФНКЦ ДГОИ им. Димтрия Рогачева Минздрава России; ГБОУ ВПО РНИМУ им. Н. И. Пирогова Минздрава РоссииРоссияFederal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Ministry of Health of Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian Federation201431032015015161Copyright © Сметанина Н.С., 20152015Сметанина Н.С.Smetanina N.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nodgo.org/jour/article/view/14

Перегрузка железом – одна из основных проблем у пациентов с наследственными и приобретенными анемиями, в лечении которых применяются регулярные трансфузии эритроцитной массы. В статье подробно разбираются все используемые в настоящее время методы оценки запасов железа в организме больного: расчетный метод, определение содержания сывороточного ферритина, измерение концентрации железа в печени как путем прямого определения содержания железа в биоптате печени, так и косвенно – с помощью магнитно-резонансной томографии (МРТ) (Т2*), содержания железа в миокарде методом МРТ (Т2*). Согласно современной концепции, больные получающие регулярные заместительные трансфузии эритроцитной массы, нуждаются в проведении адекватной хелаторной терапии, цель которой – снижение токсичного железа внутри клеток и во внеклеточном пространстве, снижение общих запасов железа в организме, что позволяет предотвратить необратимое повреждение органов и тканей, увеличить продолжительность жизни и повысить качество жизни больных. В статье приводится алгоритм хелаторной терапии (выбор хелатора при первичном назначении, модификация терапии в зависимости от терапевтической цели, прекращение хелаторной терапии). В случаях тяжелой перегрузки железом рекомендовано использовать интенсивную хелаторную терапию в виде непрерывной внутривенной инфузии дефероксамина или комбинированную терапию – одновременное или последовательное применение 2 различных хелаторов железа. В данном обзоре литературы подробно разбирается дозовый режим и возможные комбинации сочетанного применения различных хелаторов, а также критерии оценки эффективности и безопасности применения хелаторов железа.

 

 

Iron overload is one of the major problems in patients with hereditary and acquired anemias whose treatment uses regular packed red blood cell transfusions. The paper analyzes in detail all currently used iron store-estimating methods, such as a calculation method; determination of serum ferritin levels; measurement of liver iron concentration by both determining directly iron content in a biopsy specimen and indirectly by T2*-weighted magnetic resonance imaging (MRI (T2*)), estimation of myocardial iron by MRI (T2*). According to the current concept, the patients receiving regular packed red blood cell replacement transfusions need  adequate chelation therapy, the goal of which is to reduce toxic iron in the cell and the extracellular space and total body iron stores, which can prevent irreversible organ and tissue damage, increase survival, and improve quality of life in patients. The paper gives an algorithm for chelation therapy (to choose a chelating agent for its primary use, to modify therapy in relation to a treatment goal, and to discontinue chelation therapy). Intensive chelation therapy as continuous intravenous deferoxamine infusion or combined therapy (simultaneous or successive use of 2 different iron chelating agents) is recommended in case of severe iron overload. This literature review analyzes in detail the dosing regimen and possible combinations of different iron chelating agents, as well as criteria for evaluating their efficiency and safety.

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The authors declare that there are no conflicts of interest present.