[1]张蓬杰,王小艳,王坤英,等.晚期肾移植术后贫血患者应用罗沙司他治疗血液实验室指标观察及临床效果评价[J].现代检验医学杂志,2024,39(05):183-188.[doi:10.3969/j.issn.1671-7414.2024.05.034]
　ZHANG Pengjie,WANG Xiaoyan,WANG Kunying,et al.Evaluation of Laboratory Blood Parameters and Clinical Outcomes in Patients with Anemia after Advanced Kidney Transplantation Treated by Roxadustat[J].Journal of Modern Laboratory Medicine,2024,39(05):183-188.[doi:10.3969/j.issn.1671-7414.2024.05.034]
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晚期肾移植术后贫血患者应用罗沙司他治疗血液实验室指标观察及临床效果评价()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第39卷
期数:
2024年05期
页码:
183-188
栏目:
论著
出版日期:
2024-09-15

文章信息/Info

Title:
Evaluation of Laboratory Blood Parameters and Clinical Outcomes in Patients with Anemia after Advanced Kidney Transplantation Treated by Roxadustat
文章编号:
1671-7414（2024）05-183-06
作者:
张蓬杰1; 王小艳2; 王坤英3; 丁 通1; 鲍 楠1
（1. 陕西省人民医院肾病血透中心，西安 710068；2. 蒲城县医院内分泌肾病科，陕西蒲城715500；3．山西省第二人民医院肾移植中心实验室，太原 030012）
Author(s):
ZHANG Pengjie1; WANG Xiaoyan2; WANG Kunying3; DING Tong1; BAO Nan1
（1.Center of Kidney Diseases and Hemodialysis, Shaanxi Provincial People’s Hospital, Xi’an 710068，China； 2. Department of Endocrine and Nephrology, Pucheng County Hospital, Shaanxi Pucheng 715500, China; 3.Central Laboratory of Kidney Transplantation, Sha
关键词:
罗沙司他; 晚期肾移植后贫血; 血液实验室检验; 安全性分析
分类号:
R699.2；R446.11
DOI:
10.3969/j.issn.1671-7414.2024.05.034
文献标志码:
A
摘要:
目的 评价罗沙司他（Roxadustat，Rox）治疗晚期肾移植后贫血患者的血液实验室指标变化及临床效果。方法 回顾性分析陕西省人民医院肾病血透中心2020 年3 月～ 2023 年3 月收治的101 例晚期肾移植后贫血患者，其中使用罗沙司他治疗48 例（Rox 组）、使用重组人促红素（recombinant human erythropoietin，rhEPO）治疗53 例（rhEPO组），两组患者均予以铁剂以及甲钴胺和叶酸治疗。分别在治疗后1，3，6 个月观察红细胞（RBC）、血红蛋白（Hb）、促红素（erythropoietin，EPO）、血清铁蛋白（serum ferrin，SF）、转铁蛋白饱和度（transferrin saturation，TSAT）、铁调素（hepcidin，HePc）、他克莫司谷值浓度（Tacrolimous trough concentration，Tac CO）、环孢素谷值浓度（CyclosporineA trough concentration，CsA CO）、霉酚酸酯浓度时间曲线下面积（Mycophenolic acid area under curve，MPA-AUC）、淋巴细胞（Lym）、T 淋巴细胞亚群Th/Ts 比率（Th/Ts）、血清肌酐（serum creatinine，Scr）和血尿素氮(blood ureanitrogen，BUN) 的变化。并观察6 个月期间两组不良反应发生情况。结果 治疗前两组间RBC，Hb，EPO，SF，TSAT，HePc，Tac C0，CsA CO，MPA-AUC，Lym，Th/Ts，Scr，BUN 比较，差异均无统计学意义（t=-0.319~2.024，均P>0.05）。治疗1，3，6 个月后，两组RBC，Hb，EPO，SF，TSAT 较治疗前上升，HePc 较治疗前下降，组内比较差异具有统计学意义（F=234.890, 219.907；256.171, 201.231；138.023, 89.247；92.890, 215.780；189.198, 179.092；112.132, 76.127，均P<0.05）；且罗沙司他组RBC，Hb，SF 高于促红素组（F=9.672，8.165，139.360），EPO，HePc低于促红素组（F=124.437，78.147），差异具有统计学意义（均P>0.05），TSAT 两组间比较差异无统计学意义（F=7.118，P=0.119）。Tac CO，CsA CO，MPA-AUC，Lym，Th/Ts 较治疗前变化不大，Scr，BUN 较治疗前略上升，但组内及组间比较差异均无统计学意义（F=0.665，1.167，1.097，1.343，5.219，0.696，1.106，均P>0.05）。两组不良反应发生率差异无统计学意义（χ2=0.083，P=0.773）。结论 罗沙司他治疗晚期肾移植术后贫血临床疗效良好，可有效调节体内铁代谢水平，对移植患者免疫状态无明显影响，移植肾功能稳定，安全性好。
Abstract:
Objective To evalutate changes in laboratory indicators and clinical efficacy of roxadustat (Rox) in treating anemia patients after advanced kidney transplantation. Methods A retrospective analysis of 101 patients with anemia after kidney transplantation admitted to the Center of Kidney Diseases and Hemodialysis of Shaanxi Provincial People’s Hospital from March 2020 to March 2023 was performed. Among them 48 cases were treated with roxadustat (Rox group) and 53 cases were treated with recombinant human erythropoietin (rhEPO) (rhEPO group). Both groups were treated with polyferose, methycobal and folic acid.The change of red blood cell (RBC), hemoglobin (Hb), erythropoietin (EPO), serum ferrin (SF), transferrin saturation (TSAT), and hepcidin (HePc) ,tacrolimus trough concentration (Tac CO), cyclosporine A trough concentration (CsA CO), mycophenolic acid area under curve (MPA-AUC), lymphocyte (Lym), T lymphocyte subgroup Th/Ts ratio (Th/Ts), serum creatinine (Scr) and blood urea nitrogen (BUN) were observed in the 1st, 3rd and 6th month after treatment respectively. The incidence of side effect induce by medicine during 6 months between the two groups were analysed. Results Before the beginning treatment, there was no significant difference in RBC，Hb，EPO，SF，TSAT，HePc，Tac CO，CsA CO，MPAAUC， Lym，Th/Ts，Scr and BUN between the two groups and the differences were not statistisally significant (t= -0.319~2.024，all P>0.05). After the 1st，3rd and 6th month of treatment，the RBC，Hb，EPO，SF，TSAT of the two groups of patients were increased compared to before treatment, while HePc was decreased compared to before treatment, and there were significant differences within the groups (F=234.890, 219.907；256.171, 201.231；138.023, 89.247；92.89, 215.780；189.198, 179.092；112.132, 76.127, all P<0.05). The RBC, Hb and SF levels in the Rox group were higher than those in the rhEPO group (F=9.672, 8.165, 139.360), while EPO and HePc levels were lower than those in the rhEPO group (F=124.437，78.147)，and the differences were significant (all P<0.05)，There was no significant difference in TSAT between the two groups (F=7.118，P=0.119). Tac CO, CsA CO, MPA-AUC, Lym, Th/Ts showed no significant changes between groups compared to before treatment, the Scr and BUN showed a slight increase compared to before treatment，but there were no statistically significant differences in intra group and between two groups comparisons (F=0.665，1.167，1.097，1.343，5.219， 0.696，1.106，all P>0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (χ2=0.083，P=0.773). Conclusion Roxadustat has better clinical efficacy in the treatment of patients with anemia after kidney transplantation, which can effectively improve anemia and regulate iron metabolism in the body. There is no significant impact on the immune status of the transplant recipients, and the transplanted kidney function is stable and safe.

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备注/Memo

备注/Memo:
基金项目：陕西省社会发展科技攻关项目（2016SF-013），山西省“四个一批”科技兴医创新计划（2023XM027）。
作者简介：张蓬杰（1975-），男，硕士，副主任医师，研究方向：肾脏病，E-mail:13149254918@163.com。
通讯作者：鲍楠（1983-），女，硕士，主治医师，研究方向：肾脏病，E-mail: baonan@163.com。
更新日期/Last Update: 2024-09-15