摘要
目的探讨罗沙司他治疗初始血液透析患者肾性贫血的临床疗效。方法回顾分析大连瑞凯尔肾病医院2019年8月至2020年4月收治的初始血液透析(透析时间≤4个月)患者40例,分为罗沙司他组和红细胞生成刺激剂(ESA)组。罗沙司他组根据患者体重起始剂量分别为70 mg或100 mg,每周3次透析后口服;ESA组起始剂量为每周100 U/kg体重,透析后静脉注射,并根据血红蛋白(Hb)水平进行剂量调整。观察基线和治疗2周、4周、12周、24周的Hb、C-反应蛋白(CRP)和平均动脉压(MAP)水平。主要终点是24周平均Hb变化;次要终点是24周CRP下降幅度及心血管不良事件(MACE)、MACE+的发生率。结果两组患者性别、年龄、导入透析时间、原发病及基线时Hb差异无统计学意义(P>0.05)。24周时罗沙司他组平均Hb高于ESA组[(113.0±4.83)g/L vs.(106.0±5.61)g/L,P<0.05)],且在治疗2周时罗沙司他组平均Hb变化显著高于ESA组(P<0.01)。24周时罗沙司他组平均CRP较基线的下降幅度大于ESA组[(12.8±13.97)mg/L vs.(2.02±3.04)mg/L,P<0.05)]。在CRP≤10 mg/L的患者中,24周时两组Hb≥110 g/L的达标率差异无统计学意义(P>0.05);在CRP>10 mg/L的患者中,24周时罗沙司他组Hb≥110 g/L的达标率高于ESA组(95%vs.60%,P<0.01)。随访各时间点两组MAP差异无统计学意义(P>0.05)。罗沙司他组24周无MACE和MACE+的发生,ESA组MACE+1例。结论在初始血液透析患者中,与ESA相比罗沙司他纠正肾性贫血的达标率高、起效快且不受炎症的影响,对初始血液透析患者更具优势。
Objective To assess the effectiveness of roxadustat in the treatment of anemia in patients undergoing initialstage hemodialysis.Methods It was a retrospective cohort study conducted in a single center.Patients who underwent inital hemodialysis(≤4 months)from August 2019 to April 2020 Dalian Renal Care Hospital were enrolled in the study(n=40).Patients were divided into two groups roxadustat group and erythropoiesis^stimulating agents(ESA)group.The starting dose of roxadustat was either 70 mg or 100 mg according to the patients’weight,which was taken orally 3 times a week after dialysis.The starting dose of ESA was 100 U/kg per week,which was given by intravenous injection after dialysis.The level of Hb,CRP and MAP at baseline and 2,4,12 and 24 weeks of treatment was observed.The primary end point was the mean change in hemoglobin level during 24 weeks.The secondary end points were the decline of CRP and the incidence rate of MACE and MACE+in 24 weeks.Results There was no difference between two groups in age,gender,duration after initiation of hemodialysis,primary disease or the baseline hemoglobin level(P>0.05).Roxadustat led to a highter mean hemoglobin level at week 24 than ESA[(113.0±4.83)g/L vs.(106.0±5.61)g/L,P<0.05)],and the mean change in hemoglobin level at week 2 was also significantly higher(P<0.01).As compared with ESA,roxadustat decreased the mean CRP at week 24[(12.8±13.97 mg/Lvs.(2.02±3.04)mg/L,P<0.05)].In patients with CRP≤10 mg/L,the compliance rate of hemoglobin≥110 g/L in the roxadustat group was higher than that in the ESA group(95%vs.60%,P<0.01).There was no difference in MAP between the two groups at each time point(P>0.05).One MACE+occurred in the ESA group and none in the roxadustat group in 24 weeks.Conclusion Roxadustat has higher target rate,more quickly response and is not affected by inflammation.Roxadustat has advantage over ESA as therapy for anemia in patients undergoing initial-stage hemodialysis.
作者
孙艳玲
谢华
康喆
张圣坤
赵婷婷
王博文
SUN Yan-ling;XIE Hua;KANG Zhe;ZHANG Sheng-kun;ZHAO Ting-ting;WANG Bo-wen(Dalian Renal Care Hospital,Dalian 116000,China)
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2020年第11期942-946,共5页
Chinese Journal of Practical Internal Medicine
关键词
初始血液透析
肾性贫血
罗沙司他
红细胞生成刺激剂
initial-stage hemodialysis
renal anemia
Roxadustat
erythropoiesis stimulating agents
