罗沙司他对血液透析合并肾性贫血患者的治疗效果及影响因素分析

Analysis of the therapeutic effect and influencing factors about roxadustat in hemodialysis patients

目的 探讨影响罗沙司他对维持性血液透析(MHD)合并肾性贫血患者治疗效果的相关因素.方法 回顾性分析2020年1月至2021年3月在本院收治的201例MHD合并肾性贫血患者的临床资料,根据不同治疗药物分为罗沙司他组(94例)和重组人促红细胞生成素(rhEPO)组(107例).对比两组治疗12周前后的血红蛋白(Hb)、血细胞分布宽度(RDW)、高敏C-反应蛋白(hs-CRP)、铁代谢、血脂、血清促红细胞生成素(EPO)、甲状旁腺激素(PTH)等实验室指标,根据Hb是否达标对罗沙司他组分为未达标组(39例)和达标组(55例),采用logistic回归分析影响罗沙司他组Hb达标率的因素.结果 治疗12周后,两组患者的Hb较治疗前均升高,但罗沙司他组的Hb达标率高于rhEPO组(58.5%vs.40.2%,P<0.05),且罗沙司他组治疗后的血清EPO低于rhEPO组(5.57 mU/mL vs.16.76 mU/mL,P<0.05).罗沙司他组治疗后的总铁结合力较治疗前升高,而铁蛋白减低,RDW、hs-CRP水平下降,总胆固醇降低,高密度脂蛋白胆固醇/低密度脂蛋白胆固醇(HDL-C/LDL-C)升高(均P<0.05),而rhEPO组治疗后的上述指标与治疗前比较,差异均无统计学意义(均P>0.05).与未达标组相比,达标组患者治疗前的Hb较高,促红素抵抗指数(ERI)与PTH较低(均P<0.05).多因素logistic回归分析表明ERI(OR=0.750,95%CI:0.583~0.996)、PTH(OR=0.981,95%CI:0.973~0.988)是罗沙司他治疗后MHD患者Hb达标的独立影响因素.结论 罗沙司他产生较低水平的EPO,有效改善MHD患者贫血,减轻微炎症,在调节铁代谢和血脂代谢中发挥积极作用.同时,改善促红素抵抗和甲状旁腺功能亢进,有利于提高罗沙司他的Hb达标率.

Objective To explore the influencing factors of the therapeutic effect of roxadustat in maintenance hemodialysis(MHD)patients with renal anemia.Methods Clinical data of 201 patients with MHD complicated with renal anemia admitted to our hospital from January 2020 to March 2021 were retrospectively analyzed,and they were divided into rosallistat group(94 cases)and recombinant human erythropoietin(107 cases)group according to therapeutic drugs.The hemoglobin(Hb),blood cell distribution width(RDW),high sensitivity C-reactive protein(hs-CRP),iron metabolism index,blood lipid index,serum erythropoietin(EPO),parathyroid hormone(PTH)were compared between two groups before and after 12 weeks of treatment.Roxadustat group were divided into in non target group(39 cases)and target group(55 cases)according to hemoglobin standard.The logistic regression analysis was used to explore the influencing factors of Hb compliance rate in roxadustat group.Results After 12 weeks of treatment,Hb was higher in two groups than before treatment,but the Hb compliance rate in rosallistat group was higher than that in rhEPO group(58.5%vs.40.2%,P<0.05),and serum EPO after treatment in rosallistat group was lower than that in rhEPO group(5.57 mU/mL vs.16.76 mU/mL,P<0.05).Compared with before treatment,the total iron binding capacity of rosallistat group was increased,while ferritin was decreased,RDW and hs-CRP levels were decreased,cholesterol was decreased,and high density lipoprotein cholesterol/low density lipoprotein cholesterol(HDL-C/LDL-C)was increased after treatment(all P<0.05).The above indexes of rhEPO group were compared with that before treatment.There were no significant differences(all P>0.05).Compared with those who did not meet the Hb standard in the rosallistat group,the Hb level before treatment was higher,the erythropoietin resistance was lighter,and the PTH was lower in the rosallistat group(all P<0.05).Multi-factor logistics regression analysis showed that erythropoietin resistance index(OR=0.750,95%CI:0.583-0.996)and PTH(OR=0.981,95%CI:0.973-0.988)were independent influencing factors for Hb standard in MHD patients after rosallistat treatment.Conclusions Roxadustat can produce lower level of EPO,improve anemia,reduce microinflammation,regulate iron and lipid metabolism in maintenance hemodialysis patients.The improvement of erythropoietin resistance and hyperparathyroidism is helpful to improve the standard rate of hemoglobin.