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Современные возможности хелаторной терапии

https://doi.org/10.17650/2311-1267-2014-0-1-51-61

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Аннотация

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.

 

Об авторе

Наталия Сергеевна Сметанина
ФГБУ ФНКЦ ДГОИ им. Димтрия Рогачева Минздрава России; ГБОУ ВПО РНИМУ им. Н. И. Пирогова Минздрава России
Россия
Москва


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Для цитирования:


Сметанина Н.С. Современные возможности хелаторной терапии. Российский журнал детской гематологии и онкологии (РЖДГиО). 2014;(1):51-61. https://doi.org/10.17650/2311-1267-2014-0-1-51-61

For citation:


Smetanina N.S. Current possibilities of chelation therapy. Russian Journal of Pediatric Hematology and Oncology. 2014;(1):51-61. (In Russ.) https://doi.org/10.17650/2311-1267-2014-0-1-51-61

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ISSN 2311-1267 (Print)
ISSN 2413-5496 (Online)