目的 探讨初始启用罗沙司他治疗的透析患者血红蛋白波动与心脑血管事件发生的关系。 方法 选取2020年6月─2022年5月在首都医科大学附属北京安贞医院初始启用罗沙司他治疗的透析患者，治疗12月。以血红蛋白变异系数均值为界分为低血红蛋白变异系数组和高血红蛋白变异系数组，观察血红蛋白波动与心脑血管事件的关系。以血红蛋白达标率均值为界将患者分为血红蛋白高达标率亚组和血红蛋白低达标率亚组，分别在2组中分析血红蛋白变异率对心脑血管事件的影响，并计算交互P值。 结果 共入组77例透析患者，其中单用罗沙司他治疗的患者55例，联合红细胞生成素治疗的患者22例。低血红蛋白变异系数组(n=39)血红蛋白达标率高于高血红蛋白变异系数组(n=38)(Z=-5.570， P=0.001)，心脑血管事件的比例低于高变异系数组(23.08%比55.26%，χ2=-1.408，P=0.024)。Kaplan-Meier分析显示高血红蛋白变异系数组心脑血管事件高于低变异系数组(Log-rank χ2=5.012，P =0.025)。多因素COX回归分析结果显示：高血红蛋白变异系数是透析患者发生心脑血管事件的独立危险因素(OR=2.935，95% CI:1.157～7.446，P=0.023)。亚组分析结果显示无论血红蛋白达标率高或低，高血红蛋白变异系数均会增加患者发生心脑血管事件的风险(chi-squareed=1.51，交互P=0.244)。 结论 透析患者应用罗沙司他治疗时，高血红蛋白变异系数是透析患者心脑血管事件发生的独立危险因素。
王文博
,
程虹
,
卞维静
,
杨敏
,
徐潇漪
,
叶楠
,
陈文梅
,
陈岚
,
王国勤
. 应用罗沙司他治疗的透析患者血红蛋白波动与心脑血管事件发生的关系[J]. 中国血液净化, 2024
, 23(07)
: 505
-509
.
DOI: 10.3969/j.issn.1671-4091.2024.07.004
Objective This study aimed to investigate the relationship between fluctuations in hemoglobin levels and cardio-cerebrovascular events in dialysis patients initially treated with Roxadustat. Methods Dialysis patients who were initially treated with Roxadustat at Beijing Anzhen Hospital from June 2020 to May 2022 were selected and treated for 12 months. They were divided into low hemoglobin coefficient of variation group and high hemoglobin coefficient of variation group according to the mean hemoglobin variability coefficient. The relationship between fluctuations in hemoglobin levels and cardio-cerebrovascular events during the treatment period was observed. According to the mean value of hemoglobin acquired target rate the patients were divided into a high hemoglobin acquired target rate subgroup and a low hemoglobin acquired target rate subgroup, and the effect of hemoglobin variation rate on cardio-cerebrovascular events was analyzed separately in the two subgroups, and the interaction P value was calculated. Results A total of 77 patients were enrolled. Among these patients, 55 patients were treated with Roxadustat alone and 22 patients were treated with erythropoietin. During the 12-month treatment period, the low hemoglobin coefficient of variation (n=39) after hemoglobin compliance rate was higher than the high hemoglobin coefficient of variation group (n=38) (Z=-5.570, P=0.001), while the proportion of cardiovascular and cerebrovascular events was significantly lower than the high hemoglobin coefficient of variation group (23.08% vs. 55.26%, χ2= -1.408, P=0.024). Kaplan-Meier analysis showed that the incidence of cardio-cerebrovascular events in the high hemoglobin coefficient of variation group was significantly higher than that in the low hemoglobin coefficient of variation group (χ2=5.012, P=0.025). The results of the multivariate Cox regression analysis showed that the hemoglobin variation coefficient was an independent risk factor for cardio-cerebrovascular events (OR=2.935, 95% CI:1.157～7.446, P=0.023). The results of the subgroups showed that regardless of whether the hemoglobin acquired target rate was high or low, a high hemoglobin variation coefficient would increase the risk of cardio-cerebrovascular events in patients (chi-squareed=1.51, interaction P=0.244). Conclusion When using Roxadustat to treat anemia in maintenance dialysis patients, high hemoglobin variation coefficient may increase the risk of cardiovascular and cerebrovascular events in patients.
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