罗沙司他胶囊对不同年龄血液透析促红素反应低下患者血红蛋白及其变异率的影响

Influence of roxadustat on hemoglobin and its variability in patients undergoing hemodialysis at different ages

目的对比罗沙司他对不同年龄血液透析促红素反应低下患者的血红蛋白及血红蛋白变异率的影响,并观察不良反应。方法收集2019年7月至2020年10月北京航天总医院维持性血液透析且确诊为促红素反应低下患者55例,并进行回顾性队列分析。按年龄不同分为2组,老年组患者28例,年龄≥60岁;非老年组患者27例,年龄<60岁。根据体质量应用罗沙司他治疗6个月。2组均不使用铁剂,分别检测2组用药前和用药6个月后血红蛋白(Hb)、转铁蛋白饱和度和血清铁蛋白(SF)、甘油三酯(TG)及总胆固醇(TC),并计算2组患者6个月内的血红蛋白变异率(Hb-Var)及不良反应发生情况。采用SPSS 25.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ^(2)检验。结果治疗前后老年组Hb[(100.20±14.26)和(114.47±7.70)g/L]和非老年组Hb[(96.05±11.45)和(112.42±14.60)g/L]比较,差异均有统计学意义(均P<0.05)。老年组Hb-Var低于非老年组[(8.84±4.13)和(12.47±3.87)g/L],差异有统计学意义(P<0.05)。治疗前后老年组SF[(947.0±715.6)和(694.3±369.9)ng/ml],非老年组SF[(850.9±668.6)和(640.6±174.4)ng/ml]比较,差异均有统计学意义(均P<0.05);治疗前后老年组TC[(3.98±1.01)和(3.45±0.61)mmol/L],非老年组TC[(3.61±0.66)和(3.26±0.80)mmol/L]比较,差异均有统计学意义(均P<0.05);其余指标比较,差异均无统计学意义(均P>0.05)。老年组不良反应发生率为14.28%(4/28),非老年组为11.11%(3/27),差异无统计学意义(P>0.05)。结论不同年龄患者应用罗沙司他血红蛋白均可上升;不同年龄患者血红蛋白波动程度不同,需密切监测。罗沙司他可改善铁利用状态,降低铁负荷,并具有降低胆固醇的作用。

Objective To compare the influence of roxadustat on hemoglobin and its variability in the patients undergoing hemodialysis at different age and to observe the adverse reactions.Methods A retrospective cohort analysis was made of the clinical data of 55 patients with low responsiveness to erythropoietin in maintenance hemodialysis in the Beijing Aerospace General Hospital from July 2019 to October 2020.The patients were divided into two age groups:the elderly group(n=28;age>60 years)and the non-elderly group(n=27;age<60 years).Roxadustat was administered for 6 months according to body mass.No iron was used in either group.Hemoglobin(Hb),serum ferritin(SF)and transferrin saturation,the triglyceride and total cholesterol(TC)were tested before and 6 months after roxadustat administration.The hemoglobin variability(Hb-Var)and the adverse events were recorded.SPSS statistics 25.0 was used for statistical analysis.Comparison between two groups was performed using t-test orχ^(2) test depending on data type.Results Hb before and after the treatment differed significantly in both the elderly group[(100.20±14.26)vs(114.47±7.70)g/L]and the non-elderly group[(96.05±11.45)vs(112.42±14.60)g/L]respectively.Hb-Var was lower in the elderly group[(8.84±4.13)g/L]than in the non-elderly group[(12.47±3.87)g/L](P<0.05).SF decreased significantly after 6 months of treatment in the elderly group[(947.0±715.6)vs(694.3±369.9)ng/ml]and in the non-elderly group[(850.9±668.6)vs(640.6±174.4)ng/ml](P<0.05 for both).After treatment,TC decreased significantly in the elderly group[(3.98±1.01)vs(3.45±0.61)mmol/L]and in the non-elderly group[(3.61±0.66)vs(3.26±0.80)mmol/L](P<0.05 for both).There were no significant differences in other indexes(P>0.05).The incidence of adverse events was 14.28%(4/28)in the elderly group and 11.11%(3/27)in the non-elderly group,and the difference was not statistically significant(P>0.05).Conclusion Roxadustat can increase Hb in the hemodialysis patients with low responsiveness to recombinant human erythropoietin,the responses to roxadustat in patients at different age are various,especially in non-elderly group.Roxadustat can significantly increase the utilization rate of iron and decrease TC.