缺氧诱导因子稳定剂对血液透析肾性贫血患者造血功能及铁死亡的影响

Effect of hypoxia inducible factor stabilizer on hematopoietic function and ferroptosis in hemodialysis patients with renal anemia

目的研究缺氧诱导因子稳定剂罗沙司他对血液透析肾性贫血患者造血功能及铁死亡的影响。方法前瞻性研究2018年1月至2021年1月间在本院收治的90例慢性肾病(CKD)肾性贫血患者的临床资料,按照随机数字表法分为A组与B组,每组45例,A组应用罗沙司他治疗,B组应用重组人促红素注射液治疗。观察两组治疗前及治疗2、4、8周后的贫血及铁代谢相关指标、脂质代谢相关指标、血清炎症指标及药物并发症情况,并随访半年,统计两组患者的不良心血管事件发生情况。结果A组患者治疗后各时间点的血红蛋白(Hb)、红细胞压积(HCT)、红细胞计数(RBC)及血清铁蛋白(SF)水平均较治疗前显著上升(均P<0.05),甘油三酯(TG)、总胆固醇(TC)、C反应蛋白(CRP)、β2微球蛋白(β2-MG)水平均较治疗前显著下降(均P<0.05)。B组患者治疗后各时间点的Hb、SF水平均较治疗前显著上升(均P<0.05),但RBC、HCT、TG、TC、CRP及β2-MG水平较治疗前比较,差异均无统计学意义(均P>0.05)。A组治疗后各时间点的Hb、RBC、HCT、SF水平均显著高于B组(均P<0.05),TG、TC、CRP及β2-MG均显著低于B组(均P<0.05),A组治疗后各时间点的血清GPX4、PTGS2 mRNA水平均较治疗前显著下降(均P<0.05),而B组治疗后各时间点的GPX4、PTGS2 mRNA水平与治疗前比较,差异均无统计学意义(均P>0.05)。A组治疗后各时间点的GPX4、PTGS2 mRNA水平均显著低于B组(均P<0.05)。结论罗沙司他能有效调节肾性贫血患者的贫血状态,提高铁代谢,抑制铁死亡,改善脂质代谢紊乱并抑制机体炎症反应,且治疗安全性高,在治疗肾性贫血中具有良好的应用价值。

Objective To investigate the effect of hypoxia inducible factor stabilizer on hematopoietic function and iron metabolism in hemodialysis patients with renal anemia.Methods The prospective study method was applied,and 90 patients with chronicity kidney disease(CKD)complicating renal anemia in our hospital from January 2018 to January 2021 were enrolled,and equally divided into group A and group B according to random number table method,with 45 cases in each group.Group A received roxadustat,while group B received recombinant human erythropoietin injection.Anemia,iron metabolism-related indexes,lipid metabolism-related indexes,serum inflammatory indexes and drug complications were observed at baseline,2,4,8 and 12 weeks after treatment,and all patients completed a half year follow-up.Then the incidence of adverse cardiovascular events was statistically analyzed.Results Within group A,levels of hemoglobin(Hb),red blood cell(RBC),hematocrit(HCT)and serum ferritin(SF)in group A were significantly increased(all P<0.05),meantime,the levels of triglyceride(TG),total cholesterol(TC),C-reactive protein(CRP)andβ2-microglobulin(β2-MG)were significantly decreased after treatment(all P<0.05).At each time point after treatment,Hb and SF levels in group B were significantly increased(all P<0.05),while RBC,HCT,TG,TC,CRP andβ2-MG levels showed no significant changes(all P>0.05).After treatment,the levels of Hb,RBC,HCT and SF in group A were significantly higher than those in group B at each time point(all P<0.05),and the levels of TG,TC,CRP andβ2-MG in group A were significantly lower than those in group B at the same time point(all P<0.05).Serum GPX4 and PTGS2 mRNA levels in group A after treatment were significantly decreased at all time points compared with before treatment(all P<0.05),while there was no statistical significance in GPX4 and PTGS2 mRNA levels in group B at all time points compared with before treatment(all P>0.05).The mRNA levels of GPX4 and PTGS2 in group A were significantly lower than those in group B at all time points after treatment(all P<0.05).Conclusions Roxadustat in the treatment of renal anemia can effectively and safely ameliorate the iron metabolism,lipid metabolism disorder and inhibit the body inflammatory response,which is of great clinical value.