中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (07): 483-486.doi: 10.3969/j.issn.1671-4091.2022.07.005

• 临床研究 • 上一篇    下一篇

罗沙司他治疗初始血液透析患者肾性贫血临床疗效评价

傅 奕   石春珍   李 鑫    陈帮明    吴兆东    付 义    刘永芳   伍宏泽   

  1. 332000 九江，1江西省中医肾病临床医学研究中心-九江市中医院血液净化科
    410208 长沙，    2湖南中医药大学中医诊断学湖南省重点实验室
  • 收稿日期:2021-12-02 修回日期:2022-04-18 出版日期:2022-07-12 发布日期:2022-07-12
  • 通讯作者: 李鑫 E-mail:lixin20082005@163.com
  • 基金资助:
    江西省科技厅一般项目(S2016SFYBG0294)；江西省卫生健康委科技计划(20204305)；
    江西省中医药科研计划(2019A395)

Clinical efficacy of Roxadustat in the treatment of renal anemia in the initial hemodialysis patients

  1. FU Yi, Shi Chun-zhen, LI Xin, CHEN Bang-ming, WU Zhao-dong, FU Yi, LIU Yong-fang, WU Hong-ze  Department of Blood Purification, Jiangxi Provincial Clinical Nephrology Research Center of Chinese Medicine - Jiujiang Hospital of Chinese Medicine, Jiujiang 332000, China;  Hunan Provincial Key Diagnosis Laboratory of Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, China
  • Received:2021-12-02 Revised:2022-04-18 Online:2022-07-12 Published:2022-07-12

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摘要： 目的 明确罗沙司他对初始血液透析患者肾性贫血的临床疗效及安全性，为其临床应用提供
证据。 方法 选取2019年11月～2021年1月江西省中医肾病临床医学研究中心收治的初始血液透析
患者肾性贫血患者90例为对象。所有患者首次使用罗沙司他，连续治疗12周。于治疗前后分别检测血
红蛋白、红细胞计数、血清铁、血清铁蛋白、转铁蛋白饱和度、血白蛋白(ALB)、C反应蛋白(CRP)、三酰甘
油、总胆固醇、红细胞生成素(erythropoietin,EPO)、低氧诱导因子-2α(hypoxia-inducible factor-
2α,HIF-2α)、脯氨酰羟化酶(prolyl hydroxylase，PHD2)、希佩尔林道病肿瘤抑制蛋白(von Hippel
Lindau disease tumor suppressor protein，pVHL)表达水平。记录服药期间不良反应发生情况。 结
果 治疗 12 周后 ，血红蛋白达标率为 76.67%。血清铁升高(t=2.104，P=0.037)、血清铁蛋白下降
(t=2.117，P=0.035)，转铁蛋白饱和度数值稳定；与治疗前比较，治疗12周后血ALB(t=1.000，P=0.318)、
EPO(t=29.071，P=0.001)、HIF2α(t=10.709，P=0.001) 明 显 升 高 ，CRP(t=7.904，P=0.001)、PHD- 29
(t=22.662，P=0.001)、pVHL(t=22.662，P=0.001)较治疗前显著下降。服药期间患者中出现 3 例高钾血
症、4例胃肠道反应，3例感染，1例头昏，2例胸闷不适，对症治疗后均好转。 结论 罗沙司他可有效改善
初始血液透析患者肾性贫血，其作用机制可能与调控HIF2α/PHD2/EPO信号通路、改善铁代谢、抑制微炎
症状态等有关。

关键词: 罗沙司他, 肾性贫血, 初始血液透析, HIF2α/PHD2/EPO通路, 临床疗效

Abstract: 】Objective To explore the clinical efficacy and safety of Roxadustat in treatment of renal anemia in the initial hemodialysis patients. Methods A total of 90 patients with renal anemia at the initial hemodialysis stage and treated in Jiangxi Provincial Clinical Nephrology Research Center of Chinese Medicine -
Jiujiang Hospital of Chinese Medicine in the period from November 2019 to January 2021 were enrolled in
this study. They used Roxadustat for renal anemia for the first time. Roxadustat was continuously used for 12
weeks. Hemoglobin, erythrocyte count, serum iron, serum ferritin, transferrin saturation, albumin (ALB), C-reactive protein (CRP), triacylglycerol, total cholesterol, erythropoietin (EPO), hypoxia- inducible factor- 2α
(HIF-2α), prolyl hydroxylase (PHD2) and von Hipper Lindau tumor suppressor protein (pVHL) were measured before and after the Roxadustat treatment. The adverse reactions of Roxadustat were also recorded. Results After the treatment for 12 weeks, the compliance rate of hemoglobin was 76.67%, serum iron increased
(t=2.104, P=0.037), serum ferritin decreased (t=2.117, P=0.035), and transferrin saturation value remained stable; serum ALB, EPO and HIF2α increased (t=1.000, 29.071 and 10.709 respectively; P=0.318, 0.001 and
0.001 respectively), and CRP, PHD2 and pVHL decreased (t=7.904, 22.662 and 5.873 respectively; P=0.001),
as compare with those before the treatment. Adverse reactions of Roxadustat therapy included hyperkalemia
(3 cases), gastrointestinal symptoms (4 cases), infections (3 cases), chest tightness and discomfort (2 cases)
and dizziness (one case); they all improved after symptomatic treatment. Conclusion Roxadustat can effec-tively improve renal anemia in patients at the initial hemodialysis stage, probably relating to its actions on regulating HIF2α/PHD2/EPO signaling pathway, improving iron metabolism, and inhibiting micro-inflammatory
state in these patients. 

Key words: Roxadustat, Renal anemia, Initial hemodialysis, HIF2α/PHD2/EPO pathway, Clinical efficacy

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