中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (08): 564-568.doi: doi:10.3969/j.issn.1671-4091.2022.08.005

• 临床研究 • 上一篇    下一篇

罗沙司他代替重组人红细胞生成素治疗维持性透析患者肾性贫血的效果观察

李  璐    尹忠诚    冯锦红    杨  晶    邱晓楠    张 颖   

  1. 221000 徐州, 1徐州医科大学附属医院肾内科
  • 收稿日期:2021-12-13 修回日期:2022-05-17 出版日期:2022-08-12 发布日期:2022-08-12
  • 通讯作者: 张颖 E-mail:happyforeverying@126.com

The use of Roxadustat to replace recombinant human erythropoietin in the treatment of renal anemia in maintenance dialysis patients  

LI Lu, YIN Zhong-cheng, FENG Jin-hong, YANG Jing, QIU Xiao-nan, ZHANG Ying     

  1. Department of Nephrology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
  • Received:2021-12-13 Revised:2022-05-17 Online:2022-08-12 Published:2022-08-12
  • Contact: ZHANG Ying E-mail:happyforeverying@126.com

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摘要： 目的 观察罗沙司他代替重组人红细胞生成素(recombinant human erythropoietin，rhEPO)在维持性透析患者肾性贫血治疗的效果。  方法  收集2020年8月～2021年10月徐州医科大学附属医院收治的维持性透析合并肾性贫血的患者21例，根据体质量及贫血程度应用相应剂量rhEPO至少3个月但血红蛋白仍小于100g/L，改用罗沙司他治疗，平均随访时间24周，分析患者治疗前后相关指标的变化。 结果  罗沙司他治疗4周、8周、12周、16周、20周、24周红细胞计数、血红蛋白、红细胞比容均较治疗前升高(F值分别为10.290、9.053、9.858，均P＜0.001)。罗沙司他治疗后网织红细胞计数从第4周开始升高，第8周、12周、24周较治疗前差异有统计学意义(F=6.031，P＜0.001)。罗沙司他治疗12周、24周总铁结合力升高(F=9.336，P=0.002)，总胆固醇、低密度脂蛋白均降低(F值分别为14.200、12.090，均 P＜0.001)。罗沙司他治疗后网织红细胞百分比、网织红细胞血红蛋白含量、未成熟网织红细胞比率、血清铁、铁蛋白、转铁蛋白饱和度、红细胞生成素(erythropoietin，EPO)等均较治疗前差异无统计学意义 (F/t值分别为0.881、3.067、0.476、3.629、2.783、1.910、-1.020，P值分别为0.421、0.057、0.679、0.067、0.093、0.158、0.315)。 结论  在维持性透析合并肾性贫血患者应用rhEPO治疗效果欠佳的患者改用罗沙司他治疗可有效改善贫血及脂代谢，不良反应较少。

关键词: 罗沙司他, 维持性透析, 肾性贫血, 慢性肾脏病

Abstract: Objective  To observe the use of Roxadustat to replace recombinant human erythropoietin (rhEPO) in the treatment of renal anemia in maintenance dialysis (MHD) patients.  Methods  Twenty-one MHD patients complicated with renal anemia and treated in The Affiliated Hospital of Xuzhou Medical University during August 2020 to October 2021 were enrolled in this study. They were treated with rhEPO using the dose based on body mass and anemia degree for at least 3 months, but their hemoglobin continued to be <100g/L. Roxadustat was then used to replace rhEPO therapy. They were followed up for an average period of 24 weeks. Their clinical indicators were compared before and after Roxadustat therapy.  Results  After 4, 8, 12, 16, 20 and 24 weeks of Roxadustat therapy, RBC count, hemoglobin and RBC specific volume became higher(F=10.290, 9.053 and 9.858 respectively;P＜0.001); reticulocyte count increased beginning from the 4th week, and the differences were statistically significant at the 8th, 12th and 24th weeks (F=6.031, P＜0.001) as compared with that before the Roxadustat therapy; total iron binding capacity increased after 12 and 24 weeks of Roxadustat therapy (F=9.336, P=0.002); total cholesterol and low density lipoprotein decreased (F=14.200 and 12.090; P＜0.001). After Roxadustat therapy, reticulocyte percentage, hemoglobin content in reticulocytes, immature reticulocyte ratio, serum iron, ferritin, transferrin saturation and erythropoietin (EPO) level remained unchanged as compared with those before Roxadustat therapy (F=0.881, 3.067, 0.476, 3.629, 2.783 and 1.910, and t=-1.020 respectively; P=0.421, 0.057, 0.679, 0.067, 0.093, 0.158 and 0.315 respectively).  Conclusions In MHD patients complicated with renal anemia and poor responses to rhEPO treatment, Roxadustat can effectively improve anemia and lipid metabolism, with less adverse reactions.

Key words: Roxadustat, Maintenance dialysis, Renal anemia, Chronic kidney disease

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