摘要
目的探究罗沙司他联合左卡尼汀治疗糖尿病肾脏病(DKD)血液透析患者肾性贫血的效果及对铁代谢、微炎性状态和微血管并发症的影响。方法回顾性分析2020年1月至2021年10月北京老年医院89例DKD血液透析肾性贫血患者的临床资料。其中,采用重组人促红素和左卡尼汀治疗肾性贫血44例(对照组),采用重组人促红素、左卡尼汀和罗沙司他治疗肾性贫血45例(研究组),治疗3个月。比较两组疗效。于治疗前和治疗1、3个月后检测实验室指标,其中贫血相关指标包括血红蛋白、红细胞计数和红细胞平均体积(MCV),铁代谢指标包括血清铁、铁蛋白和转铁蛋白饱和度(TSAT),炎性指标包括白细胞介素-8(IL-8)、C反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)。记录不良反应;治疗后随访1年,记录糖尿病微血管并发症发生情况,包括糖尿病周围神经病变(DPN)和糖尿病视网膜病变(DR)。结果研究组总有效率明显高于对照组[93.33%(42/45)比77.27%(34/44)],差异有统计学意义(χ^(2)=4.60,P<0.05)。两组治疗前各实验室指标比较差异无统计学意义(P>0.05);研究组治疗1和3个月后血红蛋白、红细胞计数、MCV、血清铁、铁蛋白和TSAT明显高于对照组,IL-8、CRP和TNF-α明显低于对照组,差异有统计学意义(P<0.01或<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。治疗结束后随访1年,研究组失访2例,对照组失访3例。研究组DR和DPN发生率明显低于对照组[0比14.63%(6/41)和2.33%(1/43)比19.51%(8/41)],差异有统计学意义(χ^(2)=4.75和4.81,P<0.05)。结论罗沙司他联合左卡尼汀治疗DKD血液透析患者肾性贫血效果可靠且安全,可有效缓解贫血症状,提高铁代谢水平,减轻炎性反应,降低糖尿病微血管并发症发生风险。
Objective To investigate the effect of roxadustat combined with levocarnitine in the treatment of renal anemia in hemodialysis patients with diabetic kidney disease(DKD),and its effects on iron metabolism,microinflammation status and microvascular complications.Methods The clinical data of 89 hemodialysis renal anemia patients with DKD from January 2020 to October 2021 in Beijing Geriatric Hospital were retrospectively analyzed.Among them,44 patients(control group)were treated with recombinant human erythropoietin and levocarnitine for renal anemia,and 45 patients(study group)were treated with recombinant human erythropoietin,levocarnitine and roxadustat for renal anemia.Both groups were treated for 3 months.The efficacy was compared between two groups.The laboratory indexes were measured before treatment and after 1,3 months of treatment,including anemia related indexes such as hemoglobin,red blood cell count and mean corpuscular volume(MCV);iron metabolism indexes such as serum iron,ferritin and transferrin saturation(TSAT);inflammatory indexes such as interleukin-8(IL-8),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α).The adverse reactions were recorded.The patients were followed up for 1 year after treatment,the incidence of diabetic microvascular complications,including diabetic peripheral neuropathy(DPN)and diabetic retinopathy(DR),was recorded.Results The total effective rate in study group was significantly higher than that in control group:93.33%(42/45)vs.77.27%(34/44),and there was statistical difference(χ^(2)=4.60,P<0.05).There were no statistical differences in the laboratory indexes before treatment between two groups(P<0.05);the hemoglobin,red blood cell count,MCV,serum iron,ferritin and TSAT after 1 and 3 months of treatment in study group were significantly higher than those in control group,the IL-8,CRP and TNF-αwere significantly lower than those in control group,and there were statistical differences(P<0.01 or<0.05).There was no significant difference in the incidence of adverse r
作者
薛宇
韦丽
王婷婷
李亚伟
刘翠萍
Xue Yu;Wei Li;Wang Tingting;Li Yawei;Liu Cuiping(Department of Nephrology,Beijing Geriatric Hospital,Beijing 100095,China)
出处
《中国医师进修杂志》
2024年第3期254-259,共6页
Chinese Journal of Postgraduates of Medicine
关键词
糖尿病肾病
肾透析
贫血
左卡尼汀
罗沙司他
Diabetic nephropathies
Renal dialysis
Anemia
Levocarnitine
Roxadustat
