Diabetes mellitus increases the prevalence of anemia in patients with chronic kidney disease:A nested case-control study

AIM: To compare anemia prevalence between matched chronic kidney disease(CKD) patients with and without diabetes mellitus(DM) and to assess factors associated with anemia development.METHODS: This is a nested case-control study of 184 type-2 diabetic and 184 non-diabetic CKD patients from a prospectively assembled database of a Nephrology outpatient clinic, matched for gender, age and estimated glomerular filtration rate(eG FR). Prevalence of anemia(hemoglobin: Men: < 13 g/dL, women: < 12 g/dL and/or use of recombinant erythropoietin) was examined in comparison, in the total population and by CKD Stage. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with anemia.RESULTS: The total prevalence of anemia was higher in diabetics(47.8% vs 33.2%, P = 0.004). Accordingly, prevalence was higher in diabetics in CKD Stage 3(53.5% vs 33.1%, P < 0.001) and particularly in Stage 3a(60.4% vs 26.4%, P < 0.001), whereas it was nonsignificantly higher in Stage 4(61.3% vs 48.4%; P = 0.307). Serum ferritin was higher in diabetics in total and in CKD stages, while serum iron was similar between groups. In multivariate analyses, DM(OR = 2.206, 95%CI: 1.196-4.069), CKD Stages 3a, 3b, 4(Stage 4: OR = 12.169, 95%CI: 3.783-39.147) and serum iron(OR = 0.976, 95%CI: 0.968-0.985 per mg/d L increase) were independently associated with anemia.CONCLUSION: Prevalence of anemia progressively increases with advancing stages of CKD and is higher in diabetic than matched non-diabetic CKD patients and diabetes is independently associated with anemia occurrence. Detection and treatment of anemia in diabetic CKD patients should be performed earlier than non-diabetic counterparts.

Effects of hypoxia on bone metabolism and anemia in patients with chronic kidney disease

BACKGROUND Abnormal bone metabolism and renal anemia seriously affect the prognosis of patients with chronic kidney disease(CKD).Existing studies have mostly addressed the pathogenesis and treatment of bone metabolism abnormality and anemia in patients with CKD,but few have evaluated their mutual connection.Administration of exogenous erythropoietin to CKD patients with anemia used to be the mainstay of therapeutic approaches;however,with the availability of hypoxia-inducible factor(HIF)stabilizers such as roxadustat,more therapeutic choices for renal anemia are expected in the future.However,the effects posed by the hypoxic environment on both CKD complications remain incompletely understood.AIM To summarize the relationship between renal anemia and abnormal bone metabolism,and to discuss the influence of hypoxia on bone metabolism.METHODS CNKI and PubMed searches were performed using the key words“chronic kidney disease,”“abnormal bone metabolism,”“anemia,”“hypoxia,”and“HIF”to identify relevant articles published in multiple languages and fields.Reference lists from identified articles were reviewed to extract additional pertinent articles.Then we retrieved the Abstract and Introduction and searched the results from the literature,classified the extracted information,and summarized important information.Finally,we made our own conclusions.RESULTS There is a bidirectional relationship between renal anemia and abnormal bone metabolism.Abnormal vitamin D metabolism and hyperparathyroidism can affect bone metabolism,blood cell production,and survival rates through multiple pathways.Anemia will further attenuate the normal bone growth.The hypoxic environment regulates bone morphogenetic protein,vascular endothelial growth factor,and neuropilin-1,and affects osteoblast/osteoclast maturation and differentiation through bone metabolic changes.Hypoxia preconditioning of mesenchymal stem cells(MSCs)can enhance their paracrine effects and promote fracture healing.Concurrently,hypoxia reduces the inhibitory effect on osteocyte differentiation by inhibiting the expression of fibroblast growth factor 23.Hypoxia potentially improves bone metabolism,but it still carries potential risks.The optimal concentration and duration of hypoxia remain unclear.CONCLUSION There is a bidirectional relationship between renal anemia and abnormal bone metabolism.Hypoxia may improve bone metabolism but the concentration and duration of hypoxia remain unclear and need further study.

Anemia treatment and left ventricular hypertrophy in non-dialysis chronic kidney disease

To this day, the target hemoglobin level that minimizes cardiovascular risk in chronic kidney disease (CKD) patients remains unclear. When one examines the many randomized trials of epoetin therapy in aggregate, enhanced quality of life provides the most cogent argument for hemoglobin levels above 110 g/L. It remains unclear whether treatment of anemia improves longevity, or even a surrogate marker (such as left ventricular [LV] mass index), especially when applied at earlier phases of CKD.

Sickle Cell Trait, Hemoglobin Levels and Anemia among Black Patients with Predialysis Chronic Kidney Disease: A Post Hoc Analysis

Objective: To assess the relationship between SCT, hemoglobin levels and anemia in CKD black patients. Method: A post-hoc analysis of data from 188 patients, enrolled in a cross-sectional study of sickle cell trait (SCT) and chronic kidney disease (CKD), was performed to assess the relationship between SCT, hemoglobin (Hb) levels and anemia defined as Hb < 12 g/dl in men and <11 g/dl in women. Student t test, Mann Whitney and Chi square test were used as appropriate for different comparisons. P < 0.05 defined the level of statistical significance. Results: SCT (HbAS) and normal hemoglobin (HbAA) were present in 39 (21%) and 149 (79%) CKD patients, respectively. Despite similar estimated GFR (eGFR) and age, HbAS patients had significantly lower Hb levels (8.8 ± 1.8 vs 10 ± 2.2 g/dl;p = 0.001) and a higher proportion of anemia (95% vs 72%, p = 0.001). In multiple linear regression analysis, eGFR, BMI, SBP and SCT emerged as independent determinants of Hb levels. The presence of SCT was associated with 1.185 g/dl decrease in Hb levels. Conclusion: In the present case series, SCT was associated with lower Hb levels suggesting its potential contribution to the pathogenesis of CKD-associated anemia.

Assessment of Patient Perceptions about Use of Wepox Pen^TM(Recombinant Erythropoietin Delivery Device with 30,000 IU Cartridge) in the Management of Anemia in Chronic Kidney Disease Patients

Objective: To assess perceptions about ease of use and other benefits of Wepox PenTM (loaded with 30,000 IU cartridge of recombinant erythropoietin) in the management of anemia in adult chronic kidney disease (CKD) patients. Material and methods: In this prospective, observational, multicentric post marketing surveillance, adult CKD patients treated with erythropoietin were enrolled from November 2015 to December 2016 to understand their opinions about Wepox PenTM. Ease of use of pen, ease of administering accurate dose, confidence in administration and ease of storage and disposal of cartridge were assessed on five points Likert scale: 1. very easy;2. somewhat easy;3. neither easy nor difficult;4. somewhat difficult;5. very difficult. Global assessment was performed on five points scale: 1. excellent;2. very good;3. good;4. average;5. not good. Safety was recorded by checking pain and discomfort and adverse events. Results: A total of 263 patients (mean age 32.87 years;66% male;34% female) were enrolled. Number of patients reporting ease of use as “very easy” from 209 (80.7%) at baseline increased to 245 (94.6%) and 249 (96.1%) at visit 2 (p = 0.001) and visit 3 (p = 0.001) respectively. Number of “very easy” response for accurate dose increased from 236 (91.1%) at visit 1 to 246 (95%) at visit 2 (p = 0.84) and 249 (96.1%) at visit 3 (p = 0.001). Number of the patients with “no pain” at injection site increased from 177 (68.3%) at visit 1 to 205 (79.2%) and 212 (81.9%) at visit 2 (p = 0.001) and visit 3 (p = 0.001) respectively. Improvement in number of patients with “no hurt” at visit 2 (p = 0.538) and visit 3 (p = 0.286) was not statistically significant. Number of patients reporting “somewhat easy” to “very easy” confidence in self injection increased from 251 (96.9%) at visit 2 to 255 (98.5%) at visit 3. Number of patients reporting ease of storage and disposal of cartridge as “somewhat easy” to “very easy” increased from 254 (98.1%) at visit 2 to 256 (98.9%) at visit 3. According to the global assessment, 144 (56.3%) cases reported “excellent” response. “Very good” and “Good” responses were reported by 106 (41.4%) and 6 (2.3%) patients respectively. A total of 230 (98.7%) patients said that they would prefer to use erythropoietin pen device for further treatment too. Conclusion: Wepox PenTM(recombinant erythropoietin) is easy to use and does not cause significant pain or discomfort. Ability to self-administer recombinant erythropoietin with Wepox PenTM is a great advantage which can make a significant difference for both CKD patients and doctors. Storage and disposal of cartridge is also easy.

Anemia in inflammatory bowel disease: A neglected issue with relevant effects

Anemia, a common complication associated with inflammatory bowel disease (IBD), is frequently overlooked in the management of IBD patients. Unfortunately, it represents one of the major causes of both decreased quality of life and increased hospital admissions among this population. Anemia in IBD is pathogenically complex, with several factors contributing to its development. While iron deficiency is the most common cause, vitamin B12 and folic acid deficiencies, along with the effects of pro-inflammatory cytokines, hemolysis, drug therapies, and myelosuppression, have also been identified as the underlying etiology in a number of patients. Each of these etiological factors thus needs to be identified and corrected in order to effectively manage anemia in IBD. Because the diagnosis of anemia in IBD often presents a challenge, combinations of several hematimetric and biochemical parameters should be used. Recent studies underscore the importance of determining the ferritin index and hepcidin levels in order to distinguish between iron deficiency anemia, anemia due to chronic disease, or mixed anemia in IBD patients. With regard to treatment, the newly introduced intravenous iron formulations have several advantages over orally-administered iron compounds in treating iron deficiency in IBD. In special situations, erythropoietin supplementation and biological therapies should be considered. In conclusion, the management of anemia is a complex aspect of treating IBD patients, one that significantly influences the prognosis of the disease. As a consequence, its correction should be considered a specific, first-line therapeutic goal in the management of these patients.

Hyperuricemia in Hypertension and Chronic Kidney Disease: Risk Factors, Prevalence and Clinical Correlates: A Descriptive Comparative Study

Introduction: Uric acid is a product of purine metabolism and elevated serum concentration are very common in, and linked with hypertension and chronic kidney disease, conditions associated with heavy health burden and cardiovascular complications particularly in sub Sahara Africa. An assessment of factors relating hyperuricemia to hypertension and chronic kidney disease would therefore be necessary as way of mitigating the poor quality of life, morbidity and mortality associated with these diseases in low income nations. Methods: A single centre, descriptive comparative study in which the demographic, clinical and laboratory data of hypertensive and non-dialyzed chronic kidney disease (CKD) patients were analyzed. Serum biochemical parameters with uric acid, hematocrit and urine dip strip protein were assessed. Predictors of hyperuricemia were determined using multivariate analysis. Results: One hundred and thirty nine hypertensives and 69 CKD were studied. The mean age of the participants was 54.3 ± 11.7 years, hypertensives (52.9 ± 15.7 years) and CKD (57.3 ± 16.1 years). Both groups had more males, P = 0.8. Majority (78.3%) of the CKD cohorts had stage 4 or 5 (non-dialyzed) disease. The systolic and diastolic blood pressure, creatinine and uric acid were lower in hypertension than in CKD, P = 0.07, P = 0.05, P < 0.001 and P = 0.004 respectively. The hematocrit, albumin and GFR were higher in HTN than CKD, P < 0.001, P < 0.001 and P < 0.001 respectively. The prevalence of hyperuricemia was 56.2%. The mean uric acid was 505.9 ± 23.6 mmol/L, 382 7 ± 10.5 mmol/L for hypertensive and 755.9 ± 14.8 mmol/L for CKD, P < 0.001. The prevalence of systolic HTN, proteinuria, hypoalbuminemia and anemia were 51%, 75%, 46% and 59%, and were higher in males. Hyperuricemia was related to advancing age, proteinuria, elevated creatinine, hypoalbuminemia, anemia and hypertriglyceridemia. Proteinuria (OR—4.66, 95% CI—2.42 - 9.65), elevated creatinine (OR—3.12, 95% CI—2.40 - 6.92), hypoalbuminemia (OR—2.92, 95% CI—1.83 - 5.78) and anemia (OR—4.01, 95% CI—3.78 - 7.99) independently predicted hyperuricemia. Conclusion: Hyperuricemia is commoner in CKD than hypertension and was higher in males and positively correlated with the blood pressure, proteinuria and creatinine, but negatively related to hematocrit, albumin and glomerular filtration rate. Independent predictors of hyperuricemia were proteinuria, elevated creatinine, hypoalbuminemia and anemia. Measures are needed to prevent and treat hyperuricemia to reduce the health burden associated with hypertension and CKD.

Parathyroid Hormone as a Marker for the Red Cell Fragility in Different Stages of Chronic Kidney Disease

Objective: The aim of the work is to study the relationship between Red blood cell osmotic fragility and level of parathyroid hormone in patients with different stages of Chronic Kidney Disease including End Stage Renal Disease. Background: Anaemia is one of the common complications associated with Chronic Kidney Disease (CKD) responsible for the increase in the morbidity and mortality in such patients. Several factors have been attributed to causing renal anaemia, amongst which hyperparathyroidism is one of the less recognised reasons. The level of PTH in early stages of chronic kidney disease has not been much studied. The excess amount of Parathyroid Hormone (PTH) secondary to CKD has been suggested to be a causative factor for anaemia. Method: A number of chronic kidney disease patients were studied for the relationship between Red cell osmotic fragility and level of parathyroid hormone. Results: This study was conducted on a number of 111 patients with chronic kidney disease classified into three groups. The study revealed a significant fall in Hb%, along with a rise in Median Osmotic Fragility (MOF) and PTH in the CKD patients. iPTH and MOF were significantly lower in group 3 as compared with cases in group 1. Also, iPTH and MOF were significantly lower in cases in group 2 as compared with cases in group 1. Conclusions: Based on our findings, secondary hyperparathyroidism has considerable effects on erythrocyte survival, contributing to increased fragility and anemia.

Usefulness of duodenal biopsy during routine upper gastrointestinal endoscopy for diagnosis of celiac disease

AIM： To describe the trend in duodenal biopsy performance during routine upper gastrointestinal endoscopy in an adult Spanish population, and to analyze its value for the diagnosis of celiac disease in clinical practice. METHODS： A 15 year-trend （1990 to 2004） in duodenal biopsy performed when undertaking upper gastrointestinal endoscopy was studied. We analysed the prevalence of celiac disease in the overall group, and in the subgroups with anaemia and/or chronic diarrhoea. RESULTS： Duodenal biopsy was performed in 1033 of 13 678 upper gastrointestinal endoscopies （7.6%）; an increase in the use of such was observed over the study period （1.9% in 1990-1994, 5% in 1995-1999 and 12.8% in 2000-2004）. Celiac disease was diagnosed in 22 patients （2.2%）, this being more frequent in women than in men （3% and 1% respectively）. Fourteen out of 514 （2.7%） patients with anaemia, 12 out of 141 （8.5%） with chronic diarrhoea and 8 out of 42 （19%） with anaemia plus chronic diarrhoea had celiac disease. A classical clinical presentation was observed in 55% of the cases, 23% of the patients had associated dermatitis herpetiformis and 64% presented anaemia; 9% were diagnosed by familial screening and 5% by cryptogenetic hypertransaminasaemia. CONCLUSION： Duodenal biopsy undertaken during routine upper gastrointestinal endoscopy in adults, has been gradually incorporated into clinical practice, and is a useful tool for the diagnosis of celiac disease in high risk groups such as those with anaemia and/or chronic diarrhoea.

Helicobacter pylori infection in Mongolian gerbils does not initiate hematological diseases

AIM: To investigate whether Helicobacter pylori (H. pylori) infection contributes to idiopathic thrombocytopenic purpura (ITP) or iron-deficiency anemia (IDA) onset in gerbils.

Clinical and Experimental Study of Low Molecular Weight Heparin in Patients with Chronic Anemia

Objective: To preliminary study the significance of low molecular weight heparin (LMWH) in the treatment patients of with anemia of chronic diseases (ACD), and the changes in the serum levels of BMP6, hepcidin and IL-6. To preliminary study the significance of low molecular weight heparin (LMWH) in the treatment the patients with anemia of chronic diseases (ACD), and the changes in the serum levels of BMP6, hepcidin and IL-6. Methods: Used LMWH (4000 u/day, 7 - 15 days) to therapy 61 patients with ACD, and ELISA method was used to determine Hepcidin and BMP6 before and after treatment, and the determination of IL-6 by Electro-chemi-luminescence, and to analyze its clinical significance. Results: 1) In all 61 cases, the levels of Hepcidin in post-therapy were 0.82 ± 0.24 mg/L, which were lower than 1.05 ± 3.83 mg/L in pre-therapy (t = 2.5726, P < 0.05). The levels of IL-6 in post-therapy were 24.88 ± 12.58 mg/L, which were lower than 38.22 ± 31.23 mg/L in pre-therapy (t = 2.9650, P < 0.05), but there were no statistically significant both Hb and BMP6 between in pre-therapy and post-therapy (all P > 0.05). However, The levels of Hb in post-therapy were higher than in pre-therapy (t = 1.9832, P < 0.05). 2) The Hb level in the tumor anemia group after treatment was 91.18 ± 15.91 g/L, which was higher than that before treatment (85.45 ± 18.33 g/L), the difference was statistically significant (t = 1.9711, P < 0.05). 3) The levels of hepcidin and IL-6 in the tumor anemia group after treatment were 0.73 ± 0.45 mg/L and 30.33 ± 28.39 mg/ml, which were lower than those before treatment (1.09 ± 0.41 mg/L and 50.76 ± 42.10 mg/ml), respectively, the difference was statistically significant (t = 3.3941, P < 0.01 and t = 2.3597, P < 0.05). 4) There was no significant difference in all indexes in tumor anemia free group (all P > 0.05). 5) Although Hb level increased slightly in the non-tumor anemia group, there was no statistical significance (P > 0.05), and there was no statistical difference in other indexes (all P > 0.05). 6) After treatment, the level of Hb was negatively correlated with Hepcidin and IL-6 (respectively r = -0.2809, t = 2.2490, P < 0.05 and r = -0.2781, t = 2.2266, P < 0.05). Hepcidin was positively related to IL-6 (r = -0.2941, t = 2.3622, P < 0.05). There was no correlation between BMP6 and Hb, Hepcidin and IL-6 levels. Conclusion: LMWH could up-regulate the levels of Hb, and better for the degree of anemia in patients with ACD. The possible mechanism is to reduce the level of Hepcidin and IL-6.

Eosinophilic enteritis requiring differentiation from chronic enteropathy associated with SLCO2A1 gene:A case report

BACKGROUND Eosinophilic gastrointestinal disease(EGID)is a disorder characterized by infiltration of eosinophils causing mucosal damage and dysfunction of the gastrointestinal tract.The endoscopic findings of eosinophilic enteritis(EoN),an EGID variant,are nonspecific and occasionally difficult to diagnose.In contrast,chronic enteropathy associated with SLCO2A1(CEAS)is a chronic persistent small intestinal disorder characterized by endoscopic findings such as multiple oblique and circular ulcers.CASE SUMMARY We report the case of a 10-year-old boy who had suffered abdominal pain and fatigue for the preceding 6 mo.He was referred to our institute for investigation of suspected gastrointestinal bleeding because of severe anemia with hypoproteinemia and positive fecal human hemoglobin.The upper and lower gastrointestinal endoscopic findings were normal;however,double-balloon small bowel endoscopy showed multiple oblique and circular ulcers with discrete margins and mild constriction of the intestinal lumen in the ileum.The findings were highly consistent with CEAS,but urine prostaglandin metabolites were within normal limits,and no previously reported mutations in the SLCO2A1 gene were identified.Histological evaluation demonstrated moderate to severe eosinophilic infiltration localized to the small intestine suggesting a diagnosis of EoN.Clinical remission was maintained with montelukast and a partial elemental diet,but emergent surgery for bowel obstruction due to small intestinal stenosis was performed two years after the initial treatment.CONCLUSION EoN should be considered in the differential diagnosis of CEAS-like small intestinal ulcerative lesions and normal urinary prostaglandin metabolite levels.

补肾生血汤联合免疫抑制治疗慢性再生障碍性贫血患者疗效及改善疾病相关指标研究

目的探讨补肾生血汤联合免疫抑制在慢性再生障碍性贫血患者中的应用。方法该研究纳入了76例慢性再生障碍性贫血患者作为研究对象,均为临汾市人民医院2019年3月—2022年3月期间收治的患者。依据随机数字表法将患者随机分为对照组和观察组,每组各38例。对照组采用常规治疗联合免疫抑制,观察组在对照组基础上加用补肾生血汤,均连续治疗3个月。对比两组治疗后临床疗效,治疗期间不良反应发生情况,治疗前后T淋巴细胞亚群水平、骨髓碱性成纤维细胞生长因子(bFGF)、微血管密度(MVD)、血管内皮生长因子(VEGF)、外周血象指标水平。结果治疗后观察组患者的临床总有效率为97.37%,明显高于对照组的84.21%;相较于治疗前,治疗后两组患者CD3+、CD4+、CD4+/CD8+、骨髓bFGF、MVD、VEGF、白细胞(WBC)、血红蛋白(Hb)、血小板(PLT)水平均升高,CD8+水平则降低,且观察组优于对照组;治疗期间,观察组患者的不良反应总发生率10.53%较对照组的28.95%相比更低(均P<0.05)。结论补肾生血汤联合免疫抑制治疗慢性再生障碍性贫血患者具有较好的临床疗效,能够改善患者机体内的免疫功能以及骨髓造血微环境,提升其造血功能,且安全性较高。

黑地黄丸治疗慢性肾脏病肾性贫血患者的疗效及对其铁代谢的影响

目的探讨黑地黄丸治疗慢性肾脏病肾性贫血患者的疗效及对其铁代谢的影响。方法选取2020年6月—2022年6月期间我院肾内科门诊及住院部收治的80例肾性贫血患者为研究对象,采用随机数字表法分为对照组和观察组,每组各40例。对照组采取常规治疗,观察组在对照组基础上予以黑地黄丸口服,两组患者均持续治疗12周。观察比较两组患者临床疗效、不良反应,治疗前后中医证候积分、贫血纠正情况[红细胞数(Red blood cell,RBC)、血红蛋白含量(Hemoglobin,HGB)、红细胞压积(Hematocrit,HCT)]、铁代谢指标[血清铁蛋白(Serum ferritin,SF)、血清铁(Serum iron,SI)、总铁结合力(Total iron bond strength,TIBC)和转铁蛋白饱和度(Transferrin saturation,TAST)]、肾功能指标[血清尿素氮(Serum urea nitrogen,BUN)、肌酐(Serum creatinine,Scr)、计算肾小球滤过率(Estimated glomerular filtration rate,eGFR)]。结果治疗后两组患者中医证候积分较治疗前明显降低,差异有统计学意义(P<0.05);且观察组中医证候积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者RBC、HGB及HCT指标均较治疗前明显升高,差异有统计学意义(P<0.05);且观察组RBC、HGB及HCT指标明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者SF、SI及TAST指标均较治疗前明显升高,TIBC指标明显降低,差异有统计学意义(P<0.05);且观察组SF、SI及TAST指标明显高于对照组,TIBC指标明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者BUN及Scr指标均较治疗前明显降低,eGFR指标较治疗前升高,差异有统计学意义(P<0.05);且观察组BUN及Scr指标明显低于对照组,eGFR指标明显高于对照组,差异有统计学意义(P<0.05)。治疗后观察组总有效率(92.5%)明显高于对照组(75%),差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应比较,差异无统计学意义(P>0.05)。结论黑地黄丸能够纠正CKD肾性贫血患者铁代谢紊乱,改善铁代谢,继而减轻患者临床症状,改善贫血情况,最终改善患者肾脏功能,提高临床疗效,且具有较高安全性,值得推广。

罗沙司他联合右旋糖酐铁治疗非透析依赖性慢性肾脏病肾性贫血患者的效果

目的:观察罗沙司他联合右旋糖酐铁治疗非透析依赖性慢性肾脏病肾性贫血患者的效果。方法:回顾性分析2020年6月至2023年4月该院收治的198例非透析依赖性慢性肾脏病肾性贫血患者的临床资料,按照治疗方法不同将其分为对照组和观察组各99例。对照组采用右旋糖酐铁治疗,观察组在对照组基础上联合罗沙司他治疗,两组均连续治疗12周。比较两组临床疗效,治疗前后血常规指标[血红蛋白(Hb)、红细胞计数(RBC)]水平、血清铁蛋白(SF)水平、炎性因子[C反应蛋白(CRP)、白细胞介素-6(IL-6)]水平,以及不良反应发生率。结果:观察组治疗总有效率为95.96%(95/99),高于对照组的84.85%(84/99),差异有统计学意义(P<0.05);治疗后,观察组Hb、RBC、SF水平均高于对照组,差异有统计学意义(P<0.05);治疗后,观察组CRP、IL-6水平均低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:罗沙司他联合右旋糖酐铁治疗非透析依赖性慢性肾脏病肾性贫血患者可提高治疗总有效率、血常规指标水平和SF水平,降低炎性因子水平,效果优于单纯右旋糖酐铁治疗。

罗沙司他治疗慢性肾脏病合并肾性贫血临床价值研究

目的:探讨罗沙司他治疗慢性肾脏病(CKD)合并肾性贫血的临床价值。方法:选取慢性肾脏病合并肾性贫血患者102例,根据治疗方法不同分为观察组(45例)和对照组(57例)。对照组给予重组人促红细胞生成素(rHuEPO)治疗,观察组给予罗沙司他治疗,共治疗12周。比较两组患者疗效、贫血相关指标[血红蛋白(Hb)、血细胞压积(HCT)、红细胞计数(RBC)]、铁代谢指标(铁蛋白、血清铁、总铁结合力)、血脂代谢指标[胆固醇(CHOL)、甘油三酯(TG)、低密度脂蛋白(LDL)]及不良反应发生情况。结果:治疗第12周时,观察组总有效率高于对照组(P<0.05)。治疗第8、12周时,观察组铁蛋白水平低于对照组,血清铁及总铁结合力水平高于对照组(均P<0.05)。治疗第8、12周时,观察组Hb高于对照组,TG及LDL水平低于对照组(均P<0.05)。治疗第12周时,观察组RBC、HCT高于对照组,CHOL低于对照组(均P<0.05)。治疗12周内,两组患者不良反应总发生率比较差异无统计学意义(P<0.05)。结论:对于CKD合并肾性贫血患者,罗沙司他治疗效果较rHuEPO好,能更好地改善贫血相关指标,调节铁代谢及血脂代谢,且安全性较好。

慢性阻塞性肺疾病患者合并贫血的危险因素分析及风险预测模型的构建

目的:探讨慢性阻塞性肺疾病(简称“慢阻肺”)患者合并贫血的危险因素,并构建列线图预测模型。方法:回顾性选取2019年12月至2023年3月沈阳医学院附属第二医院呼吸内科收治的492例慢阻肺患者为研究对象,运用LASSO回归进行危险因素筛选,采用多因素logistic回归分析方法构建慢阻肺患者发生贫血的预测模型,并构建列线图预测模型。采用Bootstrap重抽样法对模型进行内部验证,利用校准曲线及其C指数评估模型的区分度,分别利用受试者工作特征(ROC)曲线的曲线下面积(AUC)和临床决策曲线(DCA)评价列线图预测模型的预测能力和临床适用性。结果:492例慢阻肺患者中,19.51%(96/492)的患者存在贫血。LASSO回归分析筛选出9个候选预测因子,分别为性别、肌酐、低蛋白血症、糖尿病、高血压、新型冠状病毒感染、红细胞计数(RBC)、血红蛋白(Hb)、体质量指数(BMI)。将9个候选预测因子纳入logistic回归分析,结果显示,性别为女性(OR=3.353,95%CI:1.530~7.349)、肌酐水平升高(OR=1.024,95%CI:1.010~1.037)、Hb水平升高(OR=0.928,95%CI:0.905~0.951)、合并低蛋白血症(OR=6.239,95%CI:2.845~13.678)、合并糖尿病(OR=0.198,95%CI:0.056~0.703)均为慢阻肺发生贫血的独立影响因素。采用Bootstrap法构建的列线图预测模型显示,校准曲线拟合良好,其C指数为0.933(95%CI:0.910~1.848),提示模型区分度良好,AUC为0.933(95%CI:0.910~0.957),DCA曲线显示模型具有良好的正向净收益。结论:构建的慢阻肺合并贫血列线图预测模型简便、准确,对于临床早期甄别贫血高危人群与个体化精准防治措施的制定具有一定价值。

TNF-α、INF-γ和EPO与肿瘤伴ACD造血功能低下的相关性

目的:探讨肿瘤坏死因子α(TNF-α)、干扰素γ(INF-γ)和红细胞生成素(EPO)对肿瘤伴慢性病贫血(ACD)造血功能的影响。方法:检测肿瘤患者铁代谢参数;ELISA法检测患者血清TNF-α、IFN-γ和EPO水平;观察3种细胞因子及患者血清对骨髓红系集落生成单位(CFU-E)生成的影响。结果:肿瘤伴ACD患者血清EPO水平高于正常对照,而低于IDA患者;血清TNF-α、IFN-γ水平显著升高,且与血球压积、血清铁水平负相关;TNF-α、IFN-γ可抑制正常骨髓CFU-E生成,患者血清可抑制自身骨髓CFU-E生成,rhEPO可部分纠正细胞因子对CFU-E的抑制。结论:TNFα-、IFN-γ和EPO与肿瘤伴ACD造血功能低下有关。

慢性肾病贫血及药学服务建议

慢性肾病(CKD)是我国重要的公共卫生问题,慢性肾病贫血作为CKD的重要并发症,对CKD患者的生活质量和生存率有严重影响。目前,我国慢性肾病贫血患者普遍存在达标率低和依从性差等问题,需要多学科团队协同解决。本文综述慢性肾病贫血的流行病学、疾病现状、作用机制、疾病危害、药物治疗,并提出初步的药学服务建议。药学工作者有必要融入到医疗团队中,用高质量的药学服务赢得患者的认可。

罗沙司他治疗慢性肾脏病伴肾性贫血患者的效果及安全性研究

目的:探究罗沙司他治疗慢性肾脏病伴肾性贫血患者的临床效果及安全性。方法:选取常州市第七人民医院2021年1月—2022年6月收治的慢性肾脏病伴肾性贫血患者96例,用电脑随机数字法将其分为两组,每组48例。对照组予以临床常规治疗,研究组在对照组基础上增加罗沙司他治疗。比较两组疗效、炎症因子水平、贫血相关指标及用药安全性。结果:研究组治疗总有效率明显高于对照组(P<0.05)。治疗前,两组肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及超敏C反应蛋白(hs-CRP)、降钙素原(PCT)水平比较,差异均无统计学意义(P>0.05);治疗后,两组TNF-α、IL-6、hs-CRP、PCT水平均低于治疗前,研究组均明显低于对照组(P<0.05)。治疗前,两组血红蛋白(Hb)、红细胞计数(RBC)、血清铁蛋白(SF)、铁调素(Hepc)水平比较,差异均无统计学意义(P>0.05);治疗后,两组Hb、RBC、SF水平较治疗前均有明显升高,研究组均明显高于对照组(P<0.05)。两组治疗后Hepc水平较治疗前均有明显下降,研究组明显低于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:罗沙司他用于慢性肾脏病伴肾性贫血患者的临床治疗中,患者炎症及贫血情况有明显改善,临床疗效有明显提升,且用药较为安全可控。