低氧诱导因子脯氨酸羟化酶抑制剂对促红细胞生成素抵抗的维持性血液透析患者贫血的疗效研究  

Efficacy of HIF-PHI in patients with erythropoietin resistance

作　　者：毕学青[1] 王立华 贾岚 孟甲[1] 姜埃利[1] BI Xue-qing;WANG Li-hua;JIA Lan;MENG Jia;JIANG Ai-li(Blood Purification Department of the Second Hospital of Tianjin Medical University,Tianjin 300211)

机构地区：[1]天津医科大学第二医院肾脏病血液净化科,天津300211

出　　处：《中国实用内科杂志》2023年第1期58-62,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(82170763)。

摘　　要：目的 探讨低氧诱导因子脯氨酸羟化酶抑制剂——罗沙司他对促红细胞生成素(EPO)抵抗的维持性血液透析(MHD)患者贫血的治疗情况。方法 该研究为前瞻性队列研究,纳入2021年4月至2022年2月天津医科大学第二医院肾脏病血液净化科行MHD并存在EPO抵抗的患者109例,按照随机数字表法分为三组,组1继续EPO治疗(36例);组2改为罗沙司他治疗(37例);组3为EPO联合罗沙司他(36例)。所有患者基线时及用药后每4周检测血红蛋白(Hb),根据Hb水平调整各组EPO或罗沙司他剂量。其他指标于基线和治疗第40周时检测。各组患者以C反应蛋白(CRP)5 mg/L为界分层为亚组,比较40周时各组CRP<5 mg/L亚组与CRP≥5 mg/L亚组Hb的变化。结果 3组患者入组时一般情况和化验室指标差异无统计学意义(P>0.05)。治疗40周时组2、组3患者Hb较组1升高,差异有统计学意义(P<0.001);铁调素、血清铁蛋白、总铁结合力和血EPO浓度在组2、组3较组1下降,差异有统计学意义(P<0.05);组3治疗40周后平均动脉压较组1、组2下降,差异有统计学意义(P<0.05)。组1中CRP≥5 mg/L患者治疗后Hb数值变化与CRP<5 mg/L的患者差异无统计学意义(P>0.05);组2和组3中CRP≥5 mg/L亚组患者治疗后Hb升高高于CRP<5 mg/L亚组,差异有统计学意义(P<0.05)。结论 罗沙司他对治疗EPO抵抗的MHD患者的贫血有效。Objective To investigate the effect of Roxadustat,a hypoxic-inducible proline hydroxylase inhibitor,on erythropoietin(EPO)-resistant patients with anemia. Methods This study is a prospective cohort study,a total of 109patients on MHD who met the criteria were enrolled in the Second Hospital of Tianjin Medical University from April 2021 to February 2022. Patients were divided into three groups according to the random number table method. Group 1:treatment with EPO;group 2:treatment with Roxadustat;group 3:EPO combination with Roxadustat. All patients were tested for Hb at enrollment and every 4 weeks thereafter until week 40,each group adjusted the doses of Roxadustat and(or)EPO according to the level of Hb. Other indicators were tested at enrollment and at week 40. Besides groups were stratified according to the CRP levels at baseline. The standard of stratification was CRP 5 mg/L. The magnitude of the change in the Hb was compared among each group with CRP≥5 mg/L and with that CRP<5 mg/L after 40 weeks. Results There were no statistical differences in indicators in the three groups at baseline(P>0.05). Hb levels in groups 2 and 3 were significantly higher than group 1,differences were statistically significant between the three groups(P<0.001). Hepcidin,ferritin,total iron binding capacity and EPO concentration in groups 2 and 3 were significantly decreased than groups 1,differences were statistically significant between the three groups(P<0.05). Group 1 continues with the original dose of EPO therapy,while the EPO had been completely stopped at week 33 in group 3. The doses of Roxadustat in group 2 was significantly higher than group 3,differences were statistically significant between the two groups(P<0.001). The mean arterial pressure in groups 3 decreased significantly compared to that of group2 and group 1,differences were statistically significant between the three groups(P<0.05). Each group performed stratified as bound by CRP 5mg/L:in groups 1,patients with CRP≥5 mg/L had a similar Hb vary compared t

关 键 词：维持性血液透析 促红细胞生成素抵抗 铁调素 罗沙司他 

分 类 号：R692[医药卫生—泌尿科学]