Современные возможности хелаторной терапии

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.

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