中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (02): 99-106.doi: 10.3969/j.issn.1671-4091.2021.02.007

• 临床研究 • 上一篇    下一篇

低氧诱导因子脯氨酸羟化酶抑制剂治疗透析患者肾性贫血的疗效和安全性Meta 分析

庞萍1,周先令2,谢谨锋1,孙升云2   

  1. 1暨南大学中医学院
    2暨南大学附属第一医院中医科，暨南大学肾脏内科与血液净化研究所

  • 收稿日期:2020-10-10 修回日期:2020-11-03 出版日期:2021-02-12 发布日期:2021-02-23
  • 通讯作者: 孙升云 gzssy@163.com E-mail:gzssy@163.com
  • 基金资助:
    广东省省级科技计划项目:基于极性蛋白Par1 及MMPs/TIMPs对肾间质纤维化EMT 及ECM 的作用及“补肾降浊法”的疗效机制（801206）

Efficacy and safety of HIF proly hydroxylase inhibitors vs. erythropoiesis- stimulating agents in the treatment of renal anemia in dialysis patients: a meta analysis 

  1. 1College of Traditional Chinese Medicine, Jinan University, Guangzhou 510632, China;  2Department of Traditional Chinese Nedicine The First Affiliated Hospital, Jinan University, Guangzhou 510632, China
  • Received:2020-10-10 Revised:2020-11-03 Online:2021-02-12 Published:2021-02-23
  • Contact: Shengyun N/ASun E-mail:gzssy@163.com

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摘要： 【摘要】目的通过Meta 分析比较低氧诱导因子脯氨酸羟化酶抑制剂(hypoxia-inducible factor prolyl hydroxylase inhibitors，HIF- PHIs) 和红细胞生成刺激剂(erythropoiesis- stimulating agents，ESAs)治疗透析患者肾性贫血的疗效和安全性。方法通过计算机检索PubMed、Embase 和Cochrane Library 数据库，检索时间截止到2020 年9 月15 日。纳入比较HIF-PHIs 和ESAs 治疗透析患者肾性贫血的随机对照试验。从中提取血红蛋白、铁代谢相关指标和不良反应等数据，使用Review Manager 5.3 软件对提取的数据进行Meta 分析。结果共有8 篇文献纳入研究，包括1512 名肾性贫血的透析患者。HIF-PHIs 组和ESAs 组在改善血红蛋白[MD=-0.15,95% CI(-0.35,0.05),P=0.14]、铁蛋白[MD=14.61,95% CI(-3.80,33.02),P =0.12]、铁调素[MD=-16.46,95% CI(-37.77,4.85),P =0.13]方面无统计学差异。HIF-PHIs 组在改善转铁蛋白[MD=0.27,95% CI(0.08,0.46),P=0.02]、血清铁[MD=3.29,95% CI(1.22,5.37),P＜0.01]、转铁蛋白饱和度[MD=4.15,95% CI(3.88,4.42),P＜0.01]和总铁结合力[MD=7.59,95% CI(3.68,11.50),P＜0.01]方面的疗效较ESAs 组更优。两组总不良反应发生率[OR=1.31,95% CI(0.99,1.74),P =0.06]差异无统计学意义，而HIF-PHIs 组恶心发生率[OR= 1.85, 95% CI(1.05,3.27), P =0.03]较高。结论初步证实低氧诱导因子脯氨酸羟化酶抑制剂在改善透析患者肾性贫血的疗效与安全性不亚于红细胞生成刺激剂。

关键词: 低氧诱导因子脯氨酸羟化酶抑制剂, 红细胞生成刺激剂, 透析, 肾性贫血, Meta 分析

Abstract: 【Abstract】Objective To compare the efficacy and safety of hypoxia-inducible factor prolyl hydroxylase inhibitors(HIF-PHIs) and erythropoiesis-stimulating agents (ESAs) in the treatment of renal anemia in dialysis-dependent chronic kidney disease (CKD) patients by meta-analysis. Methods We searched the databases of PubMed, Embase, Cochrane library from inception until 15th September, 2020 for randomized controlled trials of HIF-PHIs and ESAs for the treatment of renal anemia in dialysis-dependent CKD patients. Their hemoglobin(Hb) level, iron metabolism parameters and adverse reactions were extracted and analyzed by the
software of Review Manager Version 5.3. Results Eight studies comprising a total of 1,512 dialysis-dependent CKD patients with anemia were included in the analysis. No significant differences were found between HIF-PHIs group and ESAs group in terms of hemoglobin level (MD=-0.15, 95% CI: -0.35, 0.05; P=0.14), ferritin level (MD=14.61, 95% CI: -3.80, 33.02, P=0.12) and hepcidin level (MD=-16.46, 95% CI: -37.77, 4.85; P=0.13). However, HIF-PHIs group showed better efficacies in terms of transferrin level (MD=0.27, 95% CI: 0.08, 0.46; P=0.02), serum iron level (MD=3.29, 95% CI: 1.22, 5.37; P＜0.01) and transferrin saturation
(MD=4.15, 95% CI: 3.88, 4.42; P＜0.01) as compared with those in ESAs group. There were no differences in adverse reactions between the two groups (OR=1.31, 95% CI: 0.99, 1.74; P=0.06), except the higher nausea rate (OR=1.85, 95% CI: 1.05, 3.27; P=0.03) in HIF-PHIs group than in ESAs group. Conclusion The meta analysis found that the effect and safety of HIF-PHIs were similar to those of ESAs in the treatment of renal anemia in dialysis-dependent CKD patients.

Key words: Hypoxia-inducible factor prolyl hydroxylase inhibitor, Erythropoiesis-stimulating agent, Dialysis-dependent, Anemia, Meta-analysis

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