【摘要】 目的 明确罗沙司他对初始血液透析患者肾性贫血的临床疗效及安全性，为其临床应用提供证据。方法 选取2019年11月～2021年1月江西省中医肾病临床医学研究中心收治的初始血液透析患者肾性贫血患者90例为对象。所有患者首次使用罗沙司他，连续治疗12周。于治疗前后分别检测血红蛋白、红细胞计数、血清铁、血清铁蛋白、转铁蛋白饱和度、血白蛋白(ALB)、C反应蛋白(CRP)、三酰甘油、总胆固醇、红细胞生成素(erythropoietin,EPO)、低氧诱导因子-2α(hypoxia-inducible factor-2α,HIF-2α)、脯氨酰羟化酶(prolyl hydroxylase,PHD2)、希佩尔林道病肿瘤抑制蛋白(von Hippel Lindau disease tumor suppressor protein,pVHL)表达水平。记录服药期间不良反应发生情况。结果治疗12周后，血红蛋白达标率为76.67%。血清铁升高(t=2.104,P=0.037)、血清铁蛋白下降=2.117,P=0.035)，转铁蛋白饱和度数值稳定；与治疗前比较，治疗12周后血ALB(t=1.000,P=0.318)、EPO(t=29.071,P=0.001)、HIF2α(t=10.709,P=0.001)明显升高，CRP(t=7.904,P=0.001)、PHD-2922.662,P=0.001)、pVHL(t=22.662,P=0.001)较治疗前显著下降。服药期间患者中出现3例高钾血症、4例胃肠道反应，3例感染，1例头昏，2例胸闷不适，对症治疗后均好转。结论 罗沙司他可有效改善初始血液透析患者肾性贫血，其作用机制可能与调控HIF2α/PHD2/EPO信号通路、改善铁代谢、抑制微炎症状态等有关。更多还原

【Abstract】 Objective To explore the clinical efficacy and safety of Roxadustat in treatment of renal anemia in the initial hemodialysis patients. Methods A total of 90 patients with renal anemia at the initial hemodialysis stage and treated in Jiangxi Provincial Clinical Nephrology Research Center of Chinese Medicine-Jiujiang Hospital of Chinese Medicine in the period from November 2019 to January 2021 were enrolled in this study. They used Roxadustat for renal anemia for the first time. Roxadustat was continuously used for 12weeks. Hemoglobin, erythrocyte count, serum iron, serum ferritin, transferrin saturation, albumin(ALB), C-reactive protein(CRP), triacylglycerol, total cholesterol, erythropoietin(EPO), hypoxia-inducible factor-2α(HIF-2α), prolyl hydroxylase(PHD2) and von Hipper Lindau tumor suppressor protein(pVHL) were measured before and after the Roxadustat treatment. The adverse reactions of Roxadustat were also recorded. Results After the treatment for 12 weeks, the compliance rate of hemoglobin was 76.67%, serum iron increased(t=2.104, P=0.037), serum ferritin decreased(t=2.117, P=0.035), and transferrin saturation value remained stable; serum ALB, EPO and HIF2α increased(t=1.000, 29.071 and 10.709 respectively; P=0.318, 0.001 and0.001 respectively), and CRP, PHD2 and pVHL decreased(t=7.904, 22.662 and 5.873 respectively; P=0.001),as compare with those before the treatment. Adverse reactions of Roxadustat therapy included hyperkalemia(3 cases), gastrointestinal symptoms(4 cases), infections(3 cases), chest tightness and discomfort(2 cases)and dizziness(one case); they all improved after symptomatic treatment. Conclusion Roxadustat can effectively improve renal anemia in patients at the initial hemodialysis stage, probably relating to its actions on regulating HIF2α/PHD2/EPO signaling pathway, improving iron metabolism, and inhibiting micro-inflammatory state in these patients.更多还原