罗沙司他联合琥珀酸亚铁治疗维持性血液透析肾性贫血患者的疗效分析

Efficacy analysis of roxadustat combined with ferrous succinate in the treatment of maintenance hemodialysis patients with renal anemia

目的探究罗沙司他联合琥珀酸亚铁治疗维持性血液透析(maintenance hemodialysis,MHD)肾性贫血患者的疗效以及对铁代谢、红富铁激素(erythroferrone,ERFE)-铁调素(hepcidin,Hep)轴的影响。方法选取2020年1月至2021年10月河北省张家口市第一医院收治的88例进行MHD的肾性贫血患者为研究对象,采用随机数字表法分为研究组和常规组,每组44例。常规组给予重组人促红素注射液联合琥珀酸亚铁治疗,研究组给予罗沙司他联合琥珀酸亚铁治疗,两组患者均治疗3个月。比较分析两组患者治疗后的临床疗效,治疗前后的生化指标[红细胞计数(red blood cell count,RBC)、血红蛋白(hemoglobin,Hb)、平均红细胞血红蛋白(mean corpuscular hemoglobin,MCH)、平均红细胞体积(mean corpuscular volume,MCV)]、铁代谢指标[血清铁蛋白(serum ferritin,SF)、血清铁(serum iron,SI)、转铁蛋白饱和度(transferrin saturation,TSAT)]、炎症因子水平[白介素-6(interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]、ERFE-Hep轴相关指标(ERFE、Hep)以及治疗过程中的不良反应发生情况。结果治疗后,研究组患者的总有效率显著高于常规组(P<0.05)。治疗后,两组患者的Hb、RBC、MCV、MCH、SI、SF、TSAT、ERFE均显著高于治疗前(P<0.05),且研究组显著高于常规组(P<0.05);两组患者的IL-6、CRP、TNF-α、Hep均显著低于治疗前(P<0.05),且研究组显著低于常规组(P<0.05)。两组患者治疗过程中的不良反应总发生率比较差异无显著性(P>0.05)。结论罗沙司他联合琥珀酸亚铁治疗MHD肾性贫血患者疗效显著,可通过调节ERFE-Hep轴平衡,改善铁代谢,减轻肾性贫血症状及炎症反应,且安全性较好。

Objective To explore the efficacy of roxadustat combined with ferrous succinate in the treatment of maintenance hemodialysis(MHD)patients with renal anemia and the effect of iron metabolism and the ERFE-Hep axis.Method 88 patients with renal anemia with MHD admitted to our hospital from January 2020 to October 2021 were selected as the study objects.They were divided into research group and conventional group by random number table method,with 44 cases in each group.The conventional group was given recombinant human erythropoietin injection combined with ferrous succinate,and the research group was given roxadustat combined with ferrous succinate.Both groups were treated for 3 months.The clinical efficacy after treatment,biochemical parameters(RBC,Hb,MCH,MCV),iron metabolism index(SF,SI,TSAT),inflammatory factor level(IL-6,CRP,TNF-α),index of ERFE-Hep axis(ERFE,Hep)before and after treatment,and the occurrence of adverse reactions during treatment were compared and analyzed.Result After treatment,the total effective rate of the research group was significantly higher than that of the conventional group(P<0.05).After treatment,Hb,RBC,MCV,MCH,SI,SF,TSAT and ERFE in two groups were significantly higher than those before treatment(P<0.05),and the research group was significantly higher than the conventional group(P<0.05).IL-6,CRP,TNF-αand Hep in two groups were significantly lower than those before treatment(P<0.05),and the research group was significantly lower than the conventional group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Roxadustat combined with ferrous succinate is effective in the treatment of MHD renal anemia patients,and can improve iron metabolism,reduce anemia symptoms and inflammation response by regulating ERFE-Hep axis balance,with good safety.