慢性肾脏病合并肾性贫血的临床特征及罗沙司他干预效果分析

Clinical features of chronic kidney disease complicated with renal anemia and analysis of intervention effects of roxadustat

目的探讨慢性肾脏病(CKD)合并肾性贫血的临床特征及分析罗沙司他干预效果。方法前瞻性选取2021年2月至2022年2月在海南医学院第一附属医院收治的CKD合并肾性贫血患者120例为研究对象,通过问卷表收集患者临床资料,分析120例患者临床特征。按数字表法随机将患者分为研究组60例与对照组60例,对照组患者给予重组人促红细胞生成素皮下注射治疗,研究组患者给予罗沙司他口服治疗,2组均治疗12周。比较2组治疗前后贫血指标[血红蛋白(HGB)、红细胞比容(Hct)、红细胞计数(RBC)]、脂代谢指标[高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、三酰甘油(TG)、总胆固醇(TC)]、铁代谢指标[总铁结合力(TIBC)、血清铁(Fe)、铁蛋白(Fer)、转铁蛋白(TRF)、转铁蛋白饱和度(TSAT)]差异。结果51~60岁、61~70岁、71~80岁是病例数较多的年龄段;男性病例占比(66.67%)多于女性(33.33%),差异有统计学意义(χ^(2)=26.667,P<0.05)。各阶段年龄构成中CKD合并肾性贫血以轻度贫血为主,轻度贫血、中度贫血、重度贫血均以61~70岁最常见。不同程度贫血患者吸烟情况比较差异无统计学意义(P>0.05)。随着贫血程度加重,患者体重指数、睡眠时间呈下降趋势(P<0.05)。治疗后2组HGB、Hct、RBC水平与治疗前相比均显著升高(P<0.05),且研究组HGB、Hct、RBC水平均高于对照组(P<0.05)。研究组治疗后HDL水平高于治疗前,LDL、TC水平低于治疗前(P<0.05),且HDL水平高于对照组,TC水平低于对照组(P<0.05)。2组治疗后TIBC水平高于治疗前,Fer、TSAT水平低于治疗前(P<0.05);研究组Fe、TRF水平高于治疗前(P<0.05),且研究组TIBC、Fe、TRF水平高于对照组(P<0.05)。结论慢性肾脏病合并肾性贫血以轻度贫血为主,在61~70岁患者中最常见,且与吸烟比例、体重指数、睡眠时间有相关性,罗沙司他干预效果明显,可有效缓解患者贫血状态,改善机体脂代谢与铁代谢。

Objective To explore the clinical features of chronic kidney disease(CKD)complicated with renal anemia and also to analyze the intervention effects of roxadustat.Methods A total of 120 patients with CKD complicated with renal anemia treated in the hospital from February 2021 to February 2022 were prospectively selected as research subjects.The clinical data of the patients were collected through questionnaire survey,and the clinical characteristics of the 120 patients were analyzed.By the random number table method,the patients were divided into the study group(n=60)and the control group(n=60).The patients in the control group were given subcutaneous injection of recombinant human erythropoietin,while the patients in the study group were given oral roxadustat,all with a treatment course of 12 weeks.Before the differences in such anemia indicators as hemoglobin(Hb),hematocrit(Hct),red blood cell count(RBC),and lipid metabolism indicators such as high density lipoprotein cholesterol(HDL),low low density lipoprotein cholesterol(LDL),Triacylglycerol(TG),total cholesterol(TC),as well as iron metabolism indicators such as total iron binding capacity(TIBC),serum iron(Fe),ferritin(Fer),transferrin(TRF),transferrin saturation(TSAT)were compared between the 2 groups.Results The age groups within 51‑60 years old,61‑70 years old and 71‑80 years old were the prevailing ones,with the number of male cases being greater than that of female cases,and statistical significance could be noted when comparisons were made between the 2 groups(66.67%vs 33.33%,χ^(2)=26.667,(P<0.05).The 120 cases of CKD complicated with renal anemia in different stages were mainly mild anemia,moderate anemia and severe anemia,and were most commonly seen in the age group of 61‑70 years old.There was no statistical significance in smoking,when comparisons were made between the patients with different degrees of anemia(P>0.05).With the aggravation of anemia,the body mass index and sleep time of the patients displayed a downward trend(P<0.05).Repeated detection contrast analysis showed that the levels of Hb,Hct and RBC in the two groups after treatment were significantly higher than those before treatment(P<0.05),and the levels of Hb,Hct and RBC in the study group after treatment were higher than those in the control group(P<0.05).After treatment,the HDL level in the study group was higher than that before treatment,the LDL and TC levels were lower than those before treatment(P<0.05),the HDL level was higher than that in the control group and the TC level was lower than that in the control group(P<0.05).In addition,the levels of TIBC in both groups after treatment were higher than those before treatment,and the levels of Fer and TSAT were lower than those before treatment(P<0.05).The level of Fe and TRF in the study group were higher than that before treatment(P<0.05).The levels of TIBC,Fe and TRF in the study group were higher than those of the control group(P<0.05).Conclusion Chronic kidney disease complicated with renal anemia is mainly mild anemia,which is most commonly seen in the patients in the age group of 61‑70 years,and it is related to smoking,body mass index and sleep time.Roxadustat intervention could achieve obvious effects,effectively relieve anemia and improve body fat metabolism and iron metabolism of the patients.