罗沙司他对不同铁代谢状态维持性血液透析患者贫血的影响

Roxadustat on anemia in maintenance hemodialysis patients with different iron metabolism status

目的:探究罗沙司他对不同铁代谢状态维持性血液透析(MHD)患者贫血的影响。方法:纳入四川省10个透析中心的MHD肾性贫血患者96例作为研究对象。根据患者基线血清铁蛋白(SF)水平分为SF正常组(SF≤500 ng/L)和铁过载组(SF>500 ng/L)。所有受试者根据体重给予罗沙司他治疗12周。检测治疗前后受试者血红蛋白(Hb)、铁代谢指标[SF、转铁蛋白饱和度(TSAT)、总铁结合力(TIBC)],监测治疗期间的不良反应。结果:SF正常组和铁过载组治疗后Hb明显上升(P<0.001),且两组Hb的变化量差异无统计学意义(P=0.897)。两组患者治疗后SF均较治疗前下降,TIBC均较治疗前上升(P均<0.05);但铁过载组SF下降幅度更大,而TIBC上升幅度较小;两组患者的TSAT均保持稳定。治疗过程中未发现严重不良反应。结论:不同铁代谢状态下,罗沙司他均可有效纠正贫血和改善铁代谢,但铁代谢得到改善的程度不同。

Objective:To investigate the effect of Roxadustat on anemia in maintenance hemodialysis(MHD)patients with different iron metabolism status.Methodology:A prospective study,96 MHD patients with renal anemia from 10 dialysis centers in Sichuan Province were selected.According to the baseline serum ferritin(SF)level,the patients were divided into normal SF group(SF≤500 ng/L)and iron overload group(SF>500 ng/L).All subjects were treated with Roxadustat for 12 weeks according to their body weight.Hemoglobin(Hb),iron metabolism indexes[SF,transferrin saturation(TSAT),total iron binding capacity(TIBC)]were detected before and after treatment,and adverse reactions were monitored during treatment.Results:Hb in normal SF and iron overload group increased significantly compared with that before treatment(P<0.001),and there was no significant difference in Hb changes between the two groups(P=0.897).After treatment,SF decreased and TIBC increased in both groups,and the difference was statistically significant;however,SF decreased greatly and TIBC increased slightly in iron overload group.TSAT remained stable in both groups.No severe adverse reactions were found during the treatment.Conclusion:Roxadustat can effectively correct anemia and improve iron metabolism in different iron metabolism states,but there are different improvement degrees for iron metabolism.