罗沙司他替代大剂量重组人红细胞生成素治疗维持性血液透析患者贫血的疗效  

Roxadustat for anemia in maintenance hemodialysis patients treated with large dose recombinant human erythropoietin

作　　者：孙凌霜[1] 薛瑾虹 魏萌[1] 史珂慧[1] 刘华[1] 许超 蒋红利[1] SUN Lingshuang;XUE Jinhong;WEI Meng;SHI Kehui;LIU Hua;XU Chao;JIANG Hongli(Department of Blood Purification,Nephrology Hospital,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院肾脏病医院血液净化科,西安710061

出　　处：《肾脏病与透析肾移植杂志》2021年第3期217-221,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：陕西省社会发展攻关计划项目(2020SF-120)。

摘　　要：目的:观察罗沙司他替代大剂量重组人红细胞生成素(rHuEPO)治疗维持性血液透析(MHD)患者贫血的疗效。方法:收集2019年12月至2020年10月西安交通大学第一附属医院血液净化科MHD患者73例,rHuEPO用量13 805.6±5 243.9 IU/周,评估换用罗沙司他前后血红蛋白(Hb)、铁蛋白、钙、磷、甲状旁腺激素(PTH)、C反应蛋白(CRP)及血压水平。结果:73例患者接受了至少一个月以上的罗沙司他治疗,年龄51.7±14.4岁;透析龄44.9±35.7月;干体重61.3±15.4 kg。基线Hb 83.3±16.7 g/L;罗沙司他口服起始用量112.3±11.7 mg/次,3/周。罗沙司他治疗2周、4周、8周、12周、16周、24周、32周后Hb水平的平均增加3.7±14.1 g/L、8.9±17.9 g/L、14.4±16.4 g/L、18.6±0.3 g/L、21.2±17.1 g/L、28.8±16.1 g/L、30.5±23.7 g/L,与服药前比较均有统计学差异。32周后罗沙司他口服剂量为92.9±15.9 mg/次,3/周,平均Hb 109±10.4 g/L。罗沙司他治疗2~32周后铁蛋白、血钙、PTH、收缩压、舒张压与治疗前没有统计学差异。结论:使用高rHuEPO治疗肾性贫血的Hb仍不达标的MHD患者换用罗沙司他治疗后可升高Hb,且未升高血压。Objective:To observe the efficacy of Roxadustat instead of recombinant human erythropoietin(rHuEPO)in treatment of anemia in patients with maintenance hemodialysis(MHD).Methodology:Seventy-three MHD patients with rHuEPO dosage of 13805.6±5243.9 IU/week were collected from December 2019 to October 2020 in the department of blood purification of the First Affiliated Hospital of Xi′an Jiaotong University to assess hemoglobin(Hb),ferritin,Ca,Pi,PTH,CRP,and blood pressure levels before and after switching to Roxadustat.Results:Seventy-three patients were treated with Roxadustat for at least one month,age 51.7±14.4 years,of whom 56.2%were male;dialysis age 44.9±35.7 months;dry weight 61.3±15.4 kg.Baseline Hb 83.3±16.7 g/L;oral starting dosage of Roxadustat 112.3±11.7 mg/dose,3 times/week.The mean increases in Hb levels after 2,4,8,12,16,24 and 32 weeks of Roxadustat treatment were 3.7±14.1 g/L,8.9±17.9 g/L,14.4±16.4 g/L,18.6±0.3 g/L,21.2±17.1 g/L and 28.8±16.1 g/L.The mean Hb was 109±10.4 g/L after 32 weeks at a dose of 92.9±15.9 mg/dose orally,3 times/week.There were no statistical differences in ferritin,calcium,PTH,systolic on diastolic blood pressure from 2 weeks after Roxadustat treatment to 32 weeks after treatment compared to pre-treatment.Conclusion:This study found an increase in Hb after switching to Roxadustat in MHD patients whose Hb remained substandard despite treatment with high dose of rHuEPO for nephrogenic anaemia,without raising blood pressure.

关 键 词：罗沙司他 人促红细胞生成素 维持性血液透析 肾性贫血 

分 类 号：R556[医药卫生—血液循环系统疾病] R692.5[医药卫生—内科学]