罗沙司他胶囊治疗腹膜透析患者肾性贫血的效果分析

doi:10.3760/cma.j.cn441417-20250506-19019

摘要/Abstract

摘要：

目的　探讨罗沙司他胶囊对腹膜透析合并肾性贫血患者贫血指标、心功能和脂代谢水平的影响。方法　前瞻性选取2021年10月至2023年12月郑州市第三人民医院收治的腹膜透析合并肾性贫血患者113例，根据随机数字表法分为对照组（56例）和观察组（57例）。对照组男30例，女26例，年龄（45.18±12.47）岁，透析时间（23.51±6.16）个月；观察组男34例，女23例，年龄（46.97±12.08）岁，透析时间（22.89±6.07）个月。对照组给予皮下注射重组人促红细胞生成素治疗，观察组给予口服罗沙司他胶囊治疗。两组均连续治疗3个月。比较两组贫血情况、心功能、脂代谢水平及不良反应发生率。统计学方法采用χ²、t检验。结果　治疗3个月后，观察组的血红蛋白、红细胞压积、红细胞计数均高于对照组［（116.29±21.02）g/L比（105.14±22.21）g/L、（33.21±5.02）%比（29.18±4.81）%、（1.58±0.31）×10¹²/L比（1.39±0.28）×10¹²/L］，差异均有统计学意义（均P<0.05）；观察组的左心室舒张末期内径、左心室收缩末期内径、左心室后壁厚度分别为（47.56±2.34）mm、（37.59±1.13）mm、（9.67±0.19）mm，均低于对照组的（48.62±2.32）mm、（38.68±1.12）mm、（9.75±0.22）mm，差异均有统计学意义（均P<0.05）；观察组的总胆固醇、低密度脂蛋白水平均低于对照组，高密度脂蛋白水平高于对照组（均P<0.05）。观察组的不良反应总发生率为10.53%（6/57），低于对照组的25.00%（14/56）（χ²=4.062，P=0.044）。结论　罗沙司他胶囊可显著纠正腹膜透析合并肾性贫血患者的贫血指标，有效改善其心功能及脂代谢状态，有助于降低不良反应的发生风险。

关键词:

腹膜透析, 肾性贫血, 罗沙司他, 心功能

Abstract:

Objective　To investigate the effects of Roxadustat capsules on anemia indicators, cardiac function, and lipid metabolism levels in patients with peritoneal dialysis and renal anemia. Methods　A total of 113 patients with peritoneal dialysis and renal anemia who were treated at Zhengzhou Third People's Hospital from October 2021 to December 2023 were prospectively selected. They were randomly divided into a control group (56 cases) and an observation group (57 cases) using a random number table. The control group included 30 males and 26 females, with an average age of (45.18±12.47) years and a dialysis duration of (23.51±6.16) months. The observation group consisted of 34 males and 23 females, with an average age of (46.97±12.08) years and a dialysis duration of (22.89±6.07) months. The control group received subcutaneous injections of recombinant human erythropoietin, while the observation group was treated with oral Roxadustat capsules. Both groups were treated continuously for 3 months. Anemia status, cardiac function, lipid metabolism levels, and adverse reaction rates were compared between the two groups. Statistical analysis was performed using χ² and t tests. Results　After 3 months of treatment, the observation group had higher levels of hemoglobin, hematocrit, and red blood cell count than the control group [(116.29±21.02) g/L vs. (105.14±22.21) g/L; (33.21±5.02)% vs. (29.18±4.81)%; (1.58±0.31)×10¹²/L vs. (1.39±0.28)×10¹²/L], with statistically significant differences (all P<0.05). The left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and left ventricular posterior wall thickness in the observation group were (47.56±2.34) mm, (37.59±1.13) mm, and (9.67±0.19) mm, respectively, all lower than those in the control group [(48.62±2.32) mm, (38.68±1.12) mm, (9.75±0.22) mm], with significant differences (all P<0.05). The observation group had lower levels of total cholesterol and low-density lipoprotein, while high-density lipoprotein levels were higher than in the control group (all P<0.05). The overall incidence of adverse reactions in the observation group was 10.53% (6/57), lower than the 25.00% (14/56) in the control group (χ²=4.062, P=0.044). Conclusion　Roxadustat capsule can significantly correct the anemia index of peritoneal dialysis patients with renal anemia, effectively improve the cardiac function and lipid metabolism level of patients, and help to reduce the incidence of adverse reactions.

【Key words】 Peritoneal dialysis; Renal anemia; Roxadustat; Cardiac function

Key words:

Peritoneal dialysis, Renal anemia, Roxadustat, Cardiac function

侯丽霞徐亚沛王喜风.

罗沙司他胶囊治疗腹膜透析患者肾性贫血的效果分析 [J]. 国际医药卫生导报, 2025, 31(19): 3261-3266.

Hou Lixia, Xu Yapei, Wang Xifeng.

Effect of roxadustat capsules on peritoneal dialysis patients with renal anemia [J]. International Medicine and Health Guidance News, 2025, 31(19): 3261-3266.

参考文献

[1] Bao L, Bian X, Zhang A, et al. Long-term efficacy, safety, and medication compliance of roxadustat on peritoneal dialysis patients with renal anemia affected by the COVID-19 pandemic: a retrospective study[J]. Ann Palliat Med, 2022, 11(6):2017-2024. DOI: 10.21037/apm-22-555.
[2] Fujimoto D, Adachi M, Miyasato Y, et al. Efficacy of continuous erythropoietin receptor activator for end-stage renal disease patients with renal anemia before and after peritoneal dialysis initiation[J]. Clin Exp Nephrol, 2021, 25(2):191-199. DOI: 10.1007/s10157-020-01973-x.
[3] 雷丽倩,朱军军. 罗沙司他治疗促红细胞生成素低反应性肾性贫血血液透析患者疗效的影响因素[J]. 中国药物与临床,2024,24(6):364-368. DOI:10.11655/zgywylc2024.06.005.
[4] 罗雨轻,许清玉,姬利珂,等. 基于罗沙司他改善腹膜透析患者肾性贫血的真实世界研究[J]. 临床肾脏病杂志,2023,23(4):313-319. DOI:10.3969/j.issn.1671-2390.2023.04.006.
[5] Fishbane S, Pollock CA, El-Shahawy M, et al. Roxadustat versus epoetin alfa for treating anemia in patients with chronic kidney disease on dialysis: results from the randomized phase 3 ROCKIES study[J]. J Am Soc Nephrol, 2022, 33(4):850-866. DOI: 10.1681/ASN.2020111638.
[6] 赵亚洲,任艳芸,谭颖颖,等. 罗沙司他改善腹膜透析肾性贫血的疗效及安全性观察[J]. 中国医刊,2021,56(10):1125-1127. DOI:10.3969/j.issn.1008-1070.2021.10.022.
[7] 中华医学会肾脏病学分会肾性贫血诊断和治疗共识专家组.肾性贫血诊断与治疗中国专家共识(2018修订版)[J].中华肾脏病杂志,2018,34(11):860-866.DOI: 10.3760/cma.j.issn.1001-7097.2018.11.012
[8] 杨剑,李金涛,周美兰. 对比罗沙司他、rHuEPO对腹膜透析患者外周血TIBC/Hb、血压及心脑血管并发症的影响[J]. 临床和实验医学杂志,2023,22(21):2273-2277. DOI:10.3969/j.issn.1671-4695.2023.21.009.
[9] 邵淑芹,柳晓明. 腹膜透析患者认知功能损害发生的危险因素及预测模型建立[J]. 国际医药卫生导报,2024,30(13):2214-2219. DOI:10.3760/cma.j.issn.1007-1245.2024.13.019.
[10] 王欢,孙昊月,杨雪,等. 罗沙司他治疗初始腹膜透析合并肾性贫血的生存率及预后影响因素研究[J]. 中国实用内科杂志,2023,43(2):148-154. DOI:10.19538/j.nk2023020113.
[11] 任荣,陈凯旋,贾依娜西·阿扎提,等. 罗沙司他治疗腹膜透析贫血疗效及对腹膜转运能力变化的影响[J]. 实用药物与临床,2024,27(4):260-264. DOI:10.14053/j.cnki.ppcr.202404004.
[12] 王莉丽,杨蔓玲,侯儆,等. 基于促红细胞生成素、白细胞介素-6水平及血红蛋白治疗前后最大差值变化评价罗沙司他在血液透析肾性贫血患者的应用疗效与安全性[J]. 临床肾脏病杂志,2023,23(5):357-362. DOI:10.3969/j.issn.1671-2390.2023.05.002.
[13] 应刚强. 罗沙司他对脏器损伤后修复效应的研究进展[J]. 重庆医学,2021,50(23):4111-4114,4119. DOI:10.3969/j.issn.1671-8348.2021.23.033.
[14] 邱杰山,方燊燊,暨利军,等. 罗沙司他通过活化Nrf2/HO-1信号通路保护腹膜透析患者残余肾功能[J]. 中国血液净化,2025,24(3):203-207. DOI:10.3969/j.issn.1671-4091.2025.03.007.
[15] 马倩倩,王素芳,闫三华,等. 罗沙司他对血液透析患者炎症反应和氧化应激水平的影响[J]. 中国医刊,2025,60(1):34-37. DOI:10.3969/j.issn.1008-1070.2025.01.009.
[16] 朱爱民,徐晓宏,陈秋香,等. 罗沙司他对维持性腹膜透析患者贫血指标及心功能的影响[J]. 世界临床药物,2024,45(2):147-152. DOI:10.13683/j.wph.2024.02.007.
[17] Long G, Chen H, Wu M, et al. Antianemia drug roxadustat (FG-4592) protects against doxorubicin-induced cardiotoxicity by targeting antiapoptotic and antioxidative pathways[J]. Front Pharmacol, 2020, 11:1191. DOI: 10.3389/fphar.2020.01191.
[18] 王梦莹. 罗沙司他与重组人红细胞生成素:逆转合并贫血的透析患者心室重构的临床疗效比较[D]. 南京: 东南大学,2022. DOI:10.27014/d.cnki.gdnau.2022.001002.
[19] 冯杰,宋喜焕,黄琳. 血液透析及腹膜透析对非糖尿病终末期肾病患者脂质代谢的影响分析[J]. 黑龙江医药,2022,35(3):672-674. DOI:10.14035/j.cnki.hljyy.2022.03.069.
[20] 董海霞,朱燕,张少青,等. 罗沙司他对尿毒症维持性血液透析肾性贫血患者的疗效影响及作用机制研究[J]. 中国临床医生杂志,2022,50(7):800-803. DOI:10.3969/j.issn.2095-8552.2022.07.013.
[21] 王顺. 罗沙司他对腹膜透析肾性贫血患者治疗疗效及安全性研究[D]. 石家庄:河北医科大学,2022. DOI:10.27111/d.cnki.ghyku.2022.000838.
[22] 陈斌,徐妮妮. 罗沙司他治疗肾性贫血的疗效及对铁代谢和血脂代谢的影响[J]. 国际泌尿系统杂志,2023,43(6):1117-1121. DOI:10.3760/cma.j.cn431460-20221130-00282.
[23] 成水芹,周婷婷,张志宏,等. 罗沙司他和重组人促红细胞生成素对腹膜透析患者血压及心脑血管并发症的影响[J]. 肾脏病与透析肾移植杂志,2022,31(1):9-14. DOI:10.3969/j.issn.1006-298X.2022.01.002.
[24] Tian L, Wang M, Liu M, et al. Cardiovascular and renal safety outcomes of hypoxia-inducible factor prolyl-hydroxylase inhibitor roxadustat for anemia patients with chronic kidney disease: a systematic review and meta-analysis[J]. Ren Fail, 2024, 46(1):2313864. DOI: 10.1080/0886022X.2024.2313864.
[25] Wen Y, Xu Y, Tian H, et al. Cardiovascular protective effects of oral hypoxia inducible factor prolyl hydroxylase inhibitor roxadustat in the treatment of type 4 cardiorenal-anemia syndrome: protocol of a randomized controlled trial[J]. Front Med (Lausanne), 2022, 9:783387. DOI: 10.3389/fmed.2022.783387.