中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (12): 893-897.doi: 10.3969/j.issn.1671-4091.2022.12.007

• 临床研究 • 上一篇    下一篇

罗沙司他治疗红细胞生成素反应低下的血液透析患者肾性贫血的临床研究

郭罡玲   武玲宇   樊佩琦    潘振新     张 娉    李 静    王利华   

  1. 030001 太原，山西医科大学第二医院肾内科
    030006 太原，山西和济肾脏病医院肾内科
  • 收稿日期:2022-04-07 修回日期:2022-10-24 出版日期:2022-12-12 发布日期:2022-12-12
  • 通讯作者: 李静 E-mail:Lijingshiji@163.com
  • 基金资助:
    山西省卫生计生委科研课题(2017051)

The clinical study of Roxadustat in the treatment of renal anemia with low erythropoietin response in hemodialysis patients

GUO Gang-ling, WU ling-yu, FAN Pei-qi, PAN Zhen-xin, ZHANG Ping, LI Jing, WANG Li-hua   

  1. Department of Nephrology, the Second Hospital of Shanxi Medical University;  Heji Kidney Disease Hospital of Shanxi, Taiyuan 030001, China
  • Received:2022-04-07 Revised:2022-10-24 Online:2022-12-12 Published:2022-12-12
  • Contact: 030001 太原，1山西医科大学第二医院肾内科 E-mail:Lijingshiji@163.com

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摘要： 目的 观察罗沙司他治疗红细胞生成素(erythropoietin，EPO)反应低下的血液透析(hemodialysis，HD)患者肾性贫血的疗效和安全性。方法 采取回顾性自身对照设计，纳入EPO反应低下且换用罗沙司他治疗的HD患者，以换用罗沙司他治疗前定义为基线，分别观察基线和用药后各观察时间点的血红蛋白(Hb)水平、铁代谢指标、血脂、生化指标、血压、血液学指标等。并观察用药期间不良反应的发生情况。结果 共纳入42例HD患者，平均年龄(49±13)岁，透析龄(36.88±30.44)月，平均Hb(85.85±11.14)g/L，原发病为慢性肾小球肾炎22例(52.38%)，糖尿病肾病10例(23.81%)。罗沙司他治疗后第2、4、8、12、24周的平均Hb水平较基线均明显升高(F =55.590，P＜0.001)。用药后第24周的Hb达标率达83.33%(35例)，罗沙司他反应率达92.86%(39例)。应用罗沙司他治疗12～24周后，观察到血清铁   (F =6.706，P =0.003)、总铁结合力(F =32.368，P＜0.001)、红细胞比容(F =22.513，P＜0.001)、红细胞计数(F =26.738，P＜0.001)，红细胞平均体积(F =3.327，P =0.046)，红细胞平均血红蛋白含量(F =4.589，  P =0.016)明显上升，血清铁蛋白(F =3.584，P =0.037)、低密度脂蛋白(F =8.169，P=0.007)下降。所有患者均无严重不良事件的发生。 结论 罗沙司他能改善铁代谢，降低血脂，能安全有效地改善EPO反应低下的HD患者的肾性贫血。

关键词: 血液透析, 肾性贫血, 红细胞生成素反应低下, 罗沙司他

Abstract: Objective  To observe the efficacy and safety of Roxadustat in the treatment of renal anemia with low erythropoietin (EPO) response in hemodialysis (HD) patients.  Methods   The HD patients treated with Roxadustat for renal anemia and low EPO response were enrolled in this retrospective and self-controlled study. Baseline was defined as the conditions before switching to Roxadustat treatment. Hemoglobin (Hb), iron metabolism indexes, blood lipids, biochemical indexes, blood pressure and hematological indexes were measured at baseline and observation time points after treatment. Adverse drug reactions during the treatment period were collected.   Results   Forty-two HD patients were enrolled in this study. Their average age was 49±13 years old, and dialysis age was 36.88±30.44 months. The leading primary diseases were chronic glomerulonephritis (n=22, 52.38%) and diabetic nephropathy (n=10, 23.81%). The baseline Hb was 85.85±11.14 g/L. The average Hb levels at the 2nd, 4th, 8th, 12th, and 24th weeks of the treatment were significantly higher than the baseline Hb level (F=55.590, P<0.001). After 24 weeks of Roxadustat treatment, the compliance rate of Hb was 83.33% (35 cases), and the response rate to Roxadustat was 92.86% (39 cases). After 12~24 weeks of Roxadustat treatment, serum iron (F=6.706, P=0.003), total iron binding capacity (F=32.368,   P＜0.001), hematocrit (F=22.513, P＜0.001), red blood account (F =26.738, P＜0.001), mean corpuscular volume (F=3.327, P=0.046), and mean corpuscular hemoglobin (F=4.589, P=0.016) increased, and serum ferritin (F=3.584, P=0.037) and low density lipoprotein (F=8.169, P=0.007) declined. No serious adverse events occurred in these patients.  Conclusion  Roxadustat can safely and effectively improve iron metabolism, reduce blood lipids, and increase Hb level in HD patients with renal anemia and low EPO response.

Key words: Hemodialysis, Renal anemia, Roxadustat, Low erythropoietin response

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