低氧诱导因子-脯氨酰羟化酶抑制剂治疗血液透析患者肾性贫血的疗效和安全性分析  

Efficacy and safety of hypoxia inducible factor-prolyl hydroxylase inhibitors in the treatment of renal anemia in patients undergoing hemodialysis

作　　者：史亚男[1] 胡志娟[1] 赵鹏 王利军[1] 董春霞[1] 刘璟瑶 牛凯[1] 刘冰[1] SHI Ya-nan;HU Zhi-juan;ZHAO Peng;WANG Li-jun;DONG Chun-xia;LIU Jing-yao;NIU Kai;LIU Bing(Department of Nephrology,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院肾内科,河北石家庄050051

出　　处：《中国实用内科杂志》2020年第11期920-925,共6页Chinese Journal of Practical Internal Medicine

基　　金：河北省医学适用技术跟踪项目(GZ2020005)。

摘　　要：目的比较维持性血液透析肾性贫血患者应用低氧诱导因子-脯氨酰羟化酶抑制剂——罗沙司他和红细胞生成刺激剂后血红蛋白、血清铁、铁蛋白、总铁结合力、转铁蛋白饱和度、铁调素、血脂、C反应蛋白水平的变化,分析罗沙司他的有效性和安全性。方法选择2019年11月至2020年1月河北省人民医院肾内科维持性血液透析患者随机分为罗沙司他组(n=28)及红细胞生成素刺激剂(ESA)组(n=27),分别检测两组患者治疗前及治疗后第2、4、6、8、12、16、20、24周的血红蛋白,治疗前及治疗后第12、24周的铁代谢指标、铁调素、C反应蛋白、血脂、血钙、血磷等。结果两组患者基线各项指标差异无统计学意义(P>0.05);治疗24周罗沙司他组有效率高于ESA组(60.71%vs.25.93%,P<0.01);罗沙司他组转铁蛋白水平、总铁结合力及血清铁水平均高于ESA组(P<0.05),铁蛋白水平两组之间差异无统计学意义(P>0.05);罗沙司他组铁调素水平明显低于ESA组(P<0.05);C反应蛋白水平高于正常上限的患者罗沙司他组治疗后血红蛋白水平明显高于ESA组(P<0.05);两组血钙、血磷及血脂等指标差异无统计学意义(P>0.05)。试验过程中患者无严重不良事件发生。结论罗沙司他治疗肾性贫血疗效优于红细胞生成素刺激剂,且不受炎症指标影响;罗沙司他可改善血清铁代谢指标,改善铁的利用。Objective To investigate the efficacy and safety of hypoxia inducible factor-prolyl hydroxylase inhibitorsroxadustat in patients with anemia undergoing hemodialysis by comparing the levels of hemoglobin,serum iron,ferritin,total iron binding capacity,transferrin saturation,hepcidin,triglyceride and C reactive protein(CRP)in patients with treament of erythropoiesis stimulating agents(ESA).Methods Patients undergoing hemodialysis in Hebei General Hospital from 2019-11 to 2020-01 were randomly assigned into roxadustat group(n=28)and ESA group(n=27),hemoglobin was tested before and after treatment for 2,4,6,8,12,16,20 and 24 weeks,respectirely.The levels of serum iron,hepcidin,CRP,triglyceride,serum calcium,phosphorus and serum potassium were measured before and after treatment for 12 and 24 weeks.Results No significant differences were identified between the two groups in baseline data(P>0.05).The efficacy of roxadustat for anemia was higher than that of ESA after 24 weeks of treatment(60.71%vs.25.93%,P<0.01).Ferrit,total iron binding capacity and serum iron were lingher in roxadustat group compared with ESA group(P<0.05).The level of hemoglobin of roxadustat group was higher than that of ESA group in the patients whose CRP level was above upper limits of normal range after treatment(P<0.05).No significant differences was found in triglyceride,serum calcium or serum phosphorus in two groups(P>0.05).Conclusion Roxadustat is more effective than ESA in treatment of renal anemia in patients undergoing hemodialysis,and it is not affected by inflammatory factors.Roxadustat can improve serum iron metabolism.No serious adverse events have occurred during the experiment.

关 键 词：慢性肾脏病 血液透析 肾性贫血 低氧诱导因子-脯氨酰羟化酶抑制剂 红细胞生成刺激剂 铁调素 

分 类 号：R556[医药卫生—血液循环系统疾病]