罗沙司他联合蔗糖铁和促红细胞生成素治疗血液透析患者肾性贫血疗效观察

Clinical effect of roxadustat combined with iron sucrose and erythropoietin in the treatment of renal anemia of hemodialysis patients

目的探讨罗沙司他联合蔗糖铁和促红细胞生成素(EPO)治疗血液透析患者肾性贫血的疗效及对患者氧化应激的影响。方法选择2019年3月至2020年9月在东南大学附属中大医院江北院区进行血液透析超过3个月且并发肾性贫血的110例患者为研究对象,将患者随机分为对照组和观察组,每组55例。对照组患者在常规血液透析同时给予促红细胞生成素和蔗糖铁治疗,观察组在对照组治疗基础上给予口服罗沙司他100 mg,每周3次,2组患者均治疗12周。治疗前及治疗12周后,采用氰化高铁血红蛋白测定法检测患者血红蛋白(Hb)水平,放射免疫双抗原法检测患者血清铁蛋白(SF),应用普朗全自动血液细胞分析仪检测血细胞比容(Hct),全自动生物化学分析仪测定血清铁含量及总铁结合力并计算转铁蛋白饱和度(TSAT),免疫比浊法检测患者血清中超氧化物歧化酶(SOD)水平,分光光度法检测患者血清中谷胱苷肽过氧化物酶(GSH-Px)及丙二醛(MDA)水平;比较2组患者治疗期间不良反应发生情况。结果2组患者治疗12周后血清Hb、SF水平及Hct、TSAT均显著高于治疗前(P<0.05);治疗12周后,观察组患者血清Hb、SF水平及Hct、TSAT显著高于对照组(P<0.0.5)。2组患者治疗12周后血清MDA水平显著高于治疗前,血清SOD和GSH-Px水平显著低于治疗前(P<0.05);治疗12周后,观察组患者血清MDA水平显著低于对照组,血清SOD和GSH-Px水平显著高于对照组(P<0.05)。对照组患者出现消化道不适9例,肌肉关节疼痛7例,皮肤瘙痒疼痛5例,不良反应发生率为38.18%(21/55);观察组患者出现消化道不适2例,肌肉关节疼痛1例,不良反应发生率为5.45%(2/55);观察组患者不良反应发生率显著低于对照组(χ^(2)=19.850,P<0.05)。结论罗沙司他联合蔗糖铁和促红细胞生成素可显著改善血清透析患者肾性贫血,降低患者的氧化应激反应,且不良反应较少。

Objective To investigate the clinical effect of roxadustat combined with iron sucrose and erythropoietin(EPO)for renal anemia of patients with hemodialysis and the influence on oxidative stress of patients.Methods A total of 110 patients with renal anemia who received hemodialysis for more than 3 months in Jiangbei District of Zhongda Hospital Affiliated to Southeast University from March 2019 to September 2020 were selected as the study subjects,and they were randomly divided into control group and observation group,with 55 cases in each group.The patients in the control group were treated with erythropoietin and iron sucrose at the same time undergoing routine hemodialysis;based on this,the patients in the observation group took roxadustat 100 mg orally,3 times a week;the patients in the two groups were treated for 12 weeks.Before treatment and 12 weeks after treatment,the level of hemoglobin(Hb)was measured by cyanated methemoglobin assay,the serum ferric protein(SF)was measured by radioimmunodouble antigen assay,the hematocrit(Hct)was measured by Pran automatic blood cell analyzer,the serum iron content and total iron binding capacity was determined by using biochemical analyzer and the transferrin saturation(TSAT)was calculated;the serum superoxide dismutase(SOD)level was detected by immunoturbidimetry,and the serum glutathione peroxidase(GSH-PX)and malondialdehyde(MDA)levels were detected by spectrophotometry.The incidence of adverse reactions during treatment was compared between the two groups.Results The levels of serum Hb,SF and Hct,TSAT of patients after 12 weeks of treatment were significantly higher than those before treatment in the two groups(P<0.05);after 12 weeks of treatment,the levels of Hb,SF,Hct and TSAT of patients in the observation group were significantly higher than those in the control group(P<0.0.5).The serum MDA level of patients after 12 weeks of treatment was significantly higher than that before treatment in the two groups(P<0.05),the serum SOD and GSH-Px levels of patients after 12 weeks of treatment were significantly lower than those before treatment in the two groups(P<0.05).After 12 weeks of treatment,the serum MDA level of patients in the observation group was significantly lower than that in the control group(P<0.05),the serum SOD and GSH-Px levels of patients in the observation group were significantly higher than those in the control group(P<0.05).In the control group,there were 9 cases of gastrointestinal discomfort,7 cases of muscle and joint pain,and 5 cases of skin itching and pain,the incidence of adverse reactions was 38.18%(21/55);in the observation group,there were 2 cases of gastrointestinal discomfort,1 case of muscle and joint pain,the incidence of adverse reactions was 5.45%(2/55).The incidence of adverse reactions of patients in the observation group was significantly lower than that in the control group(χ^(2)=19.850,P<0.05).Conclusion Roxadustat combined with iron sucrose and erythropoietin can significantly improve renal anemia of hemodialysis patients,reduce the oxidative stress response of patients,and has fewer adverse reactions.