罗沙司他对维持性血液透析患者贫血及FGF-23的影响

Effect of roxadustat on anemia and FGF-23 of patients with maintenance hemodia lysis

目的 比较罗沙司他(Roxadustat, ROX)、重组人促红细胞生成素(Recombinant human erythropoietin, rhEPO)治疗维持性血液透析(Maintenance hemodialysis, MHD)患者贫血的效果及其对成纤维细胞生长因子23(FGF-23)的影响。方法 选取2021年10月1日至2022年4月1日于蚌埠医学院第一附属医院血液透析中心采用维持性血液透析治疗的肾性贫血患者共42例,根据治疗方式的不同分为ROX组、rhEPO组。ROX组22例,采用罗沙司他治疗;rhEPO组20例,采用重组人促红细胞生成素治疗。记录治疗前及治疗4、8、12周后血红蛋白(Hb),治疗前及治疗12周后红细胞计数(RBC)、血细胞比容(Hct)、钙(Ca)、磷(P)、血清全段甲状旁腺激素(iPTH)、血清铁蛋白(Fer)、铁调素(Hepc)、转运铁蛋白饱和度(TSAT)及FGF-23等。结果 治疗4周、8周、12周后,ROX组Hb高于治疗前(P<0.05)。治疗4周后,rhEPO组Hb与治疗前比较,差异无统计学意义(P>0.05),治疗8、12周后高于治疗前(P<0.05)。治疗4周后,ROX组、rhEPO组Hb比较,差异无统计学意义(P<0.05),治疗8、12周后,ROX组Hb高于rhEPO组(P<0.05)。治疗12周后,ROX组RBC、Hct、TSAT较治疗前升高(P<0.05),Fer、Hepc、FGF-23均降低(P<0.05),Ca、P、iPTH与治疗前比较,差异无统计学意义(P>0.05);rhEPO组RBC、Hct均较治疗前明显升高(P<0.05),Fer、Hepc、TSAT、Ca、P、iPTH及FGF-23与治疗前比较差异无统计学意义(P>0.05)。治疗12周后,ROX组RBC、Hct、TSAT高于rhEPO组(P<0.05),Hepc、FGF-23低于rhEPO组(P<0.05);两组Fer、Ca、P、iPTH比较,差异无统计学意义(P>0.05)。结论 罗沙司他改善维持性血液透析患者肾性贫血效果不劣于rhEPO;罗沙司他可显著降低骨代谢相关指标FGF-23水平;在未使用铁剂治疗的情况下,罗沙司他可改善铁代谢。

Objective To compare the effects of roxadustat(ROX)and recombinant human erythropoietin(rhEPO)on anemia and FGF-23 in patients with maintenance hemodialysis.Methods A total of 42 renal anemia patients undergoing maintenance hemodialysis in the Hemodialysis Center of the First Affiliated Hospital of Bengbu Medical College from October 1st,2021 to April 1st,2022 were selected,and they were divided into ROX group and rhEPO group according to different treatment methods.A total of 22 patients in ROX group were treated with roxadustat,and 20 patients in rhEPO group were treated with recombinant human erythropoietin.The levels of hemoglobin(Hb)before treatment and at 4,8 and 12 weeks after treatment were recorded.The levels of red blood cell(RBC),hematocrit(Hct),calcium(Ca),phosphorus(P),serum intact parathyroid hormone(iPTH),serum ferritin(Fer),hepcidin(Hepc),transferin saturation(TSAT)and fibroblast growth factor 23(FGF-23)were recorded before and at 12 weeks after treatment.Results The Hb in ROX group at 4,8 and 12 weeks after treatment was higher than that before treatment(P<0.05);Hb in rhEPO group had no significant difference at 4 weeks after treatment compared with that before treatment(P>0.05),and it was higher at 8 and 12 weeks after treatment than that before treatment(P<0.05);there was no significant difference in Hb between the two groups at 4 weeks after treatment(P<0.05),while Hb in ROX group was higher than that in rhEPO group at 8 and 12 weeks after treatment(P<0.05).At 12 weeks after treatment,the levels of RBC,Hct and TSAT in ROX group were increased significantly(P<0.05),while the levels of Fer,Hepc and FGF-23 decreased(P<0.05),and there was no significant difference in Ca,P or iPTH(P>0.05)compared with before treatment;RBC and Hct in rhEPO group were increased(P<0.05),while no significant difference was observed in Fer,Hepc,TSAT,Ca,P,iPTH and FGF-23(P>0.05)compared with before treatment.At 12 weeks after treatment,the levels of RBC,Hct and TSAT in ROX group were higher than those in rhEPO group(P<0.05),while Hepc and FGF-23 were lower than those in rhEPO group(P<0.05);there was no significant difference in Fer,Ca,P or iPTH between the two groups(P>0.05).Conclusion Roxadustat and recombinant human erythropoietin have similar effects on improving renal anemia in maintenance hemodialysis patients.Roxadustat can significantly reduce the level of FGF-23,a bone metabolism related index.In the absence of iron treatment,roxadustat can improve iron metabolism.