低氧诱导因子脯氨酰羟化酶抑制剂对尿毒症透析患者心血管指标及心脑血管并发症影响研究  

Effect of hypoxia inducible factor prolylhydroxylase inhibitors on cardiovascular system and cardiovascular complications in uremic dialysis patients

作　　者：侯明冉 李忠心[1] HOU Ming-ran;LI Zhong-xin(Department of Nephrology,Beijing Luhe Hospital Capital Medical University,Beijing 101100,China)

机构地区：[1]首都医科大学附属北京潞河医院肾内科,北京101100

出　　处：《中国实用内科杂志》2024年第2期159-163,共5页Chinese Journal of Practical Internal Medicine

基　　金：中国健康促进基金会医疗服务能力建设专项基金之“慧研卓识”期刊战略合作项目的公益支持。

摘　　要：目的观察低氧诱导因子脯氨酰羟化酶抑制剂和重组人促红细胞生成素(r HuEPO)对尿毒症透析患者心血管指标和心脑血管并发症的影响。方法回顾性研究2022年1月1日至2022年12月31日期间于首都医科大学附属北京潞河医院肾内科服用罗沙司他的透析患者53例,按照1∶1的比例随机选取皮下注射rHuEPO的透析患者53例,比较两组患者基线及治疗12个月时血红蛋白(Hb)、血压及心血管指标,并比较治疗18个月间心脑血管并发症发生情况。结果两组基线资料及实验室检查指标差异无统计学意义(P>0.05)。治疗12个月时,两组Hb对比差异无统计学意义(P>0.05);与治疗前相比,两组Hb均显著升高,差异有统计学意义(P<0.05)。治疗12个月时,罗沙司他组夜间高血压比例低于对照组,左心室射血分数(LVEF)高于对照组,差异有统计学意义(P<0.05);与基线相比,治疗12个月后对照组夜间高血压比例、收缩压和舒张压升高,两组LVEF和白蛋白均升高,差异有统计学意义(P<0.05)。随访至18个月时,对照组发生心力衰竭比例高于罗沙司他组(χ^(2)=1.940,P=0.010)。多因素Cox回归分析发现使用rHuEPO是透析患者发生心脑血管并发症的独立危险因素(HR 2.22,95%CI 1.13~4.33,P=0.020)。结论与rHuEPO相比,罗沙司他对血压及心血管指标影响较小,可改善LVEF,降低透析患者血压升高及心脑血管并发症的发生风险。Objective To compare the influence of hypoxia inducible factor prolylhydroxylaseinhibitors and recombinant human erythropoietin(rHuEPO)on cardiovascular indicators and cardiovascular and cerebrovascular complications in renal anemia patients undergoing dialysis.Method 53 patients who were treated with Roxadustat via oral administration for renal anemia in Beijing Luhe Hospital Capital Medical University from January 1,2022 to December 31,2022 as Roxadustat group were retrospectively analyzed.Patients who were treated with rHuEPO via subcutaneous injection were randomly enrolled in according toa ratio of 1∶1 as rHuEPO group.The hemoglobin,blood pressure,cardiovascular indexes,cardiocerebrovascular complications were compared between the two groups before and after 12 monthstreatment,and cerebrovascular complications were compared during 18 months of treatment.Results There were no significant differences in baseline clinical data and laboratory values between the twogroups(P>0.05).After 12 months of follow-up,there was no statistical difference in Hb levels between the two groups after follow-up(P>0.05),andHb in both groups was significantly increased compared with the baseline(P<0.05).After 12 months of treatment,the proportion of nocturnal hypertension in Roxadustat group was lower than that in control group,and left ventricular ejection fraction(LVEF)was higher than that in control group,the difference was statistically significant(P<0.05).Compared with baseline,after 12 months of treatment,the proportion of nocturnal hypertension,SBP and DBP increased in the control group,and LVEF and albumin increased in both groups,the difference was statistically significant(P<0.05).At 18 months follow-up,the rate of heart failure in the control group was higher than that in the Roxadustatgroup(χ^(2)=1.940,P=0.010).Multivariate Cox regression analysis showed that use of rHuEPO was an independent risk factor for cardiovascular and cerebrovascular complications in dialysis patients(HR 2.22,95%CI 1.13~4.33,P=0.020).Conclusi

关 键 词：低氧诱导因子脯氨酰羟化酶抑制剂 重组人促红细胞生成素 尿毒症透析 心脑血管并发症 

分 类 号：R692.5[医药卫生—泌尿科学]