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    罗沙司他与红细胞生成刺激剂对腹膜透析患者疗效的影响

    Effect of roxadustat and erythropoiesis-stimulating agents on efficacy in peritoneal dialysis patients

    • 摘要: 目的 比较罗沙司他与红细胞生成刺激剂(ESAs)对腹膜透析(PD)患者贫血及心血管安全性的影响。方法 回顾性分析2019年1月—2024年1月徐州医科大学第二附属医院收治的205例PD患者,其中90例口服罗沙司他(罗沙司他组),115例使用ESAs (ESAs组)。分析2组治疗前后血红蛋白(Hb)、血脂、血压、心功能变化,以及心血管并发症发生情况。所有患者随访48周。结果 罗沙司他组和ESAs组基线Hb水平分别为(96.44±24.40) g/L和(95.91±16.50) g/L,第48周均显著升高至(120.07±21.90) g/L和(117.64±19.30) g/L (P<0.001),2组第48周时血红蛋白达标率也均升高(P<0.05)。罗沙司他组(他汀/非他汀)与ESAs他汀组患者第48周胆固醇水平较治疗前均下降(P<0.05)。ESAs组和罗沙司他组基线射血分数分别为(48.0±6.87)%和(49.00±6.58)%,第48周升高至(57.60±4.06)%和(56.00±4.97)%(P<0.05)。ESAs高剂量组平均动脉压较基线值升高(115.0±11.3) mmHg vs (109.0±10.2) mmHg,1 mmHg=0.133 kPa,P<0.05,罗沙司他各亚组间无显著变化。ESAs组心血管事件发生率(26例)显著高于罗沙司他组(9例),差异有统计学意义(P=0.017)。结论 罗沙司他可显著改善PD患者肾性贫血,且心血管事件发生率低于ESAs。

       

      Abstract: Objective To compare the effects of roxadustat versus erythropoiesis-stimulating agents (ESAs) on anemia and cardiovascular safety in peritoneal dialysis (PD) patients.Methods A retrospective analysis was conducted on 205 PD patients who were admitted to the Second Affiliated Hospital of Xuzhou Medical University from January 2019 to January 2024. Among them, 90 patients received oral roxadustat (a roxadustat group), and 115 received ESAs (an ESA group). Both groups were compared for hemoglobin (Hb), blood lipids, blood pressure, cardiac function, and incidence of cardiovascular events before and after treatment. All patients were followed up for 48 weeks.Results Baseline Hb levels were (96.44±24.40) g/L in the roxadustat group and (95.91±16.50) g/L in the ESA group. By week 48, Hb levels significantly increased to (120.07±21.90) g/L and (117.64±19.30) g/L (P<0.001). The target achievement rate of Hb also significantly improved in both groups at week 48 (P<0.05). Cholesterol levels on week 48 significantly decreased compared to baseline in both the roxadustat (statin/non-statin) group and the ESA (statin) group (P<0.05). Baseline ejection fraction (EF) was (48.00±6.87)% in the ESA group and (49.00±6.58)% in the roxadustat group, which increased to (57.60±4.06)% and (56.00±4.97)% at week 48, respectively (P<0.05). In the high-dose ESA subgroup, mean arterial pressure significantly increased from baseline (115.0±11.3) mmHg vs. (109.0±10.2) mmHg, P<0.05, while no significant changes were observed among the roxadustat subgroups. The incidence of cardiovascular events was significantly higher in the ESA group (26 cases) than in the roxadustat group (9 cases) (P=0.017).Conclusions Roxadustat significantly improves renal anemia in PD patients, with a lower incidence of cardiovascular events than ESAs.

       

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