基于倾向性评分探讨低氧诱导因子脯氨酰羟化酶抑制剂对维持性血液透析患者冠脉钙化的影响  

Effect of hypoxia-inducible factor prolyl hydroxylase inhibitor on coronary calcification in maintenance hemodialysis patients based on propensity score

作　　者：尧鹏 江玉波 李萃萃 何敬东 任思冲 王少清 YAO Peng;JIANG Yubo;LI Cuicui;HE Jingdong;REN Sichong;WANG Shaoqing(Department of Nephrology,The Second Affiliated Hospital of Chengdu Medical College,The Nuclear Industry 416 Hospital,Chengdu 610051,China;Chengdu Medical College,Chengdu 610500,China;Department of Physical Examination Center,The General Hospital of Western Theater Command PLA,Chengdu 610083,China;Department of Nephrology,The First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]成都医学院第二附属医院·核工业四一六医院肾内科,四川成都610051 [2]成都医学院,四川成都610500 [3]中国人民解放军西部战区总医院体检中心,四川成都610083 [4]成都医学院第一附属医院肾内科,四川成都610500

出　　处：《西部医学》2024年第8期1190-1195,1201,共7页Medical Journal of West China

基　　金：国家自然科学基金青年基金项目(818039672);四川省科技创新创业苗子工程项目重点项目(2023JDRC0089);成都市卫健委医学科研课题(2021022);中关村肾病血液净化创新联盟CKD青年研究基金项目(NBPIA20QC0202);成都医学院科研基金一般项目(CYZYB20-225);四川省医学会(青年创新)科研课题(S20060);金牛区医学会肾脏专项课题重点项目(JNZD20-01)。

摘　　要：目的观察低氧诱导因子脯氨酰羟化酶抑制剂对维持性血液透析患者冠状动脉钙化的影响。方法选取2019年6月—2021年12月在成都医学院第一附属医院和成都医学院第二附属医院血液净化中心维持性血液透析(MHD)的265例患者,根据是否使用罗沙司他胶囊,分为对照组(230例)和罗沙司他组(35例)。收集MHD患者一般资料,检测血清临床指标;应用CT扫描计算MHD患者冠脉钙化积分。两组的抽样比较采用两个样本独立t检验、秩和检验。采用带有卡钳值(标准差为25%)的1∶4匹配倾向性评分,在匹配后得出的伪人群数据中进一步统计分析出两者间的冠脉钙化积分、血钙、血红蛋白、铁蛋白、低密度脂蛋白及胆固醇水平的差异。结果倾向性评分结果显示,两组冠脉钙化积分比较,差异无统计学意义(P>0.05);与对照组相比,罗沙司他组血红蛋白和铁蛋白均升高(P<0.05),血钙明显降低(P<0.05);两组低密度脂蛋白和胆固醇比较差异均无统计学意义(P>0.05)。结论使用罗沙司他可以提升维持性血液透析患者的血红蛋白和铁蛋白含量,降低血钙水平,不增加血管钙化的风险,为罗沙司他在维持性血液透析患者的使用在心血管安全性方面提供证据。Objective To observe the effect of hypoxic inducible factor prolyl hydroxylase inhibitors on coronary artery calcification in maintenance hemodialysis patients.Methods From June 2019 to December 2021,265 patients with maintenance hemodialysis(MHD)in the blood purification center of the First Affiliated Hospital of Chengdu Medical College and the Second Affiliated Hospital of Chengdu Medical College were selected as the research objects.They were divided into the control group(230 cases)and the roxadustat group(35 cases)according to whether they used roxadustat capsule or not.The general data of MHD patients were collected.The chest CT plain scan was performed with spiral CT,and the coronary artery calcification score of all MHD patients was calculated according to Agatston's quantitative method of coronary artery calcification.The t-test and rank sum test were used for the sampling comparison between the losartal group and the control group.Using the 1:4 matching propensity score with caliper value(standard deviation of 25%),the differences in coronary artery calcification score,blood calcium,hemoglobin,ferritin,low-density lipoprotein and cholesterol levels between the two groups were further statistically analyzed in the pseudo population data obtained after matching.Results Compared with the control group,there was no statistical significance in coronary artery calcification score in roxadustat group(P>0.05).Compared with control group,hemoglobin and ferritin in roxadustat group were increased(P<0.05).Serum calcium in roxadustat group was significantly decreased compared with control group(P<0.05).Compared with control group,low density lipoprotein and cholesterol in roxadustat group had no statistical significance(P>0.05).Conclusion Based on the propensity score,the use of rosalrestat increases hemoglobin and ferritin content,reduces blood calcium levels and does not increase the risk of vascular calcification in maintenance hemodialysis patients,providing evidence for the cardiovascular safety of rosalrestat

关 键 词：慢性肾脏病 冠脉钙化 罗沙司他 维持性血液透析 

分 类 号：R459.5[医药卫生—治疗学]