罗沙司他对血液透析患者左心功能量化评估的回顾性研究

Quantitative assessment of Roxadustat on left ventricular function in patients undergoing hemodialysis

目的应用二维超声心脏牛眼图量化评估罗沙司他对血液透析患者左心功能的影响。方法回顾性选取2019年6月至2020年6月大连瑞凯尔肾病院血液透析患者36例,均口服罗沙司他纠正肾性贫血,起始剂量根据体重分别为70 mg(≤60 kg)或100 mg(>60 kg);随访12个月,观察基线及治疗后的血红蛋白(Hb)、NT-proBNP、C反应蛋白(CRP)、血脂等水平的变化。常规超声心动图检测室间隔厚度(IVST)、二尖瓣舒张早期血流峰值速度(E)与二尖瓣环舒张早期运动峰值速度(e’)比值(E/e’)、左心室射血分数(LVEF)等的变化;二维心脏超声牛眼图检测左心室整体应变值(GLPS-Avg)和左心室峰值应变离散度(PSD)等的变化。结果罗沙司他治疗后Hb较基线明显升高[(97.9±17.7)g/L比(110.6±12.5)g/L,P<0.05],而NT-proBNP、CRP和血脂在治疗前后无差异。常规超声心动图结果提示罗沙司他治疗后IVST较基线降低[(13.09±1.94)mm比(12.85±1.81)mm,P<0.05],LVEF较基线明显升高[(49.60±9.12)%比(53.76±9.07)%,P<0.05],余参数无变化。二维心脏超声牛眼图结果提示罗沙司他治疗后LVEF≥50%组(n=14)和<50%组(n=22)两组的GLPS-Avg绝对值均较基线明显升高(P<0.01);罗沙司他治疗后LVEF≥50%组PSD较基线明显降低(71.75±34.28比63.97±30.89,P<0.01),但LVEF<50%组无变化。Spearman相关分析提示Hb变异率与血清胆固醇水平呈负相关(r=-0.708,P<0.01);Logistic回归分析提示Hb变异率>20%是PSD的主要保护因素OR 7.58(95%CI0.239~17.598),P<0.05。结论罗沙司他通过纠正肾性贫血在短期内可以改善血液透析患者的左心功能,二维心脏超声牛眼图可以早期发现心肌损伤,是量化评估血液透析患者左心功能的新指标。

Objective To quantitatively evaluate the effect of roxadustat on left ventricular function in patients undergoing hemodialysis using illustration of the bull eye map with two-dimensional echocardiography.Methods Totally 36 patients who had hemodialysis in Dalian Renal Care Hospital from June 2019 to June 2020 were involved.All of the patients were giren oral roxadustat with the initial dose of 70 mg(≤60 kg)or 100 mg(>60 kg)according to the body weight.The changes of hemoglobin(Hb),NT-proBNP,C-reactive protein(CRP)and serum lipid were observed at baseline and after 12 months treatment.Ventricular septal thickness(IVST),the ratio of Epeak to e’peak(E/e’)and left ventricular ejection fraction(LVEF)were measured by routine echocardiography.Left ventricular global strain(GLPs-Avg)and left ventricular peak strain dispersion(PSD)were measured by the bull eye map with two-dimensional echocardiography.Results Hb was significantly higher than that of baseline(97.9±17.7 g/L vs.110.6±12.5 g/L,P<0.05)ofter treatmint,while there was no difference in NT-proBNP,CRP or serum lipid before and after the treatment of roxadustat.The results of routine echocardiography showed that IVST after treatment was lower than at baseline(13.09±1.94 mm vs.12.85±1.81 mm,P<0.05),while LVEF was significantly higher than at baseline(49.60±9.12%vs.53.76±9.07%,P<0.05),and the other parameters had no change.The results of the bull eye map showed that the absolute values of GLPs-Avg in LVEF≥50%group(n=14)and<50%group(n=22)were both higher than those at baseline(P<0.01).PSD in the LVEF≥50%group was significantly lower than that at baseline(71.75±34.28 vs.63.97±30.89,P<0.01),but there was no change in the LVEF<50%group.Spearman correlation analysis showed that the change rate of Hb was negatively correlated with the level of serum cholesterol(r=-0.708,P<0.01).Logistic regression analysis showed that Hb change rate>20%was the main protective factor for PSD[OR 7.58(95%CI 0.239-17.598),P<0.05].Conclusion Roxadustat can improve the left ventricular function of patients with hemodialysis in a short time by correcting renal anemia.The illustration of the bull eye with two-dimensional echocardiographyis can quantitively assess theleft ventricular function to detect early myocardial injury in patients with memodialysis.