罗沙司他治疗血液透析合并肾性贫血1例

顾琳 夏春英 邵维斌

[摘要] 肾性贫血是终末期肾病常见并发症，肾性贫血传统治疗药物一般是促红细胞生成素（Erythropoietin，EPO）及其类似物，同时包括铁剂、维生素B12、叶酸等，而传统用药具有其局限性，如EPO在上世纪八九十年代大规模运用于临床，虽然很大程度上改善了慢性肾脏病（chronic kidney diseas，CKD）合并肾性贫血患者的预后，但仍有部分患者对EPO存在抵抗，同时长期使用EPO会增加高血压及血管栓塞等不良后果，而静脉补铁也存在呼吸困难、心肌梗死及过敏等风险。罗沙司他作为低氧诱导因子脯氨酰羟化酶抑制剂（Hypoxia inducible factor prolyl hydroxylase inhibitor，HIF-PHI）是一种治疗肾性贫血的全新药物，有可能避免传统疗法的局限性。目前本血液净化中心研究1例血液透析合并肾性贫血患者使用EPO及铁剂效果不佳故而改用罗沙司他。

[关键词] 罗沙司他;终末期肾病;血液透析;肾性贫血

[中图分类号] R692.5;R556          [文献标识码] C          [文章编号] 1673-9701（2021）07-0162-04

Roxastat in treatment of hemodialysis combined with renal anemia： A case report

GU Lin   XIA Chunying   SHAO Weibin

Department of Nephrology， Affiliated People's Hospital of Jiangsu University， Zhenjiang  212002， China

[Abstract] Renal anemia is a common complication of end-stage renal disease. The traditional treatment of renal anemia is generally erythropoietin（EPO） and its analogs， including iron， vitamin B12， and folic acid. While traditional drugs had their limitations. For example， EPO was widely used in clinics in the 1980s and 1990s. Although it has greatly improved the prognosis of patients with chronic kidney disease（CKD） and renal anemia， there are still some patients who are resistant to EPO. At the same time， long-term use of EPO will increase the adverse effects of high blood pressure and vascular embolism. Intravenous iron supplementation also has the risk of dyspnea， myocardial infarction， and allergies. Roxastat， as a hypoxia inducible factor prolyl hydroxylase inhibitor（HIF-PHI）， is a new drug for the treatment of renal anemia， which may avoid the limitations of traditional therapies. At present， a case of hemodialysis complicated with renal anemia in our blood purification center changed to Roxastat because of the poor effect of using EPO and iron. The introduction is as follows.

[Key words] Roxastat; End-stage renal disease; Hemodialysis; Renal anemia

眾所周知，肾脏受损后，EPO合成相应减少，患者出现肾性贫血。此并发症在终末期肾脏病血液透析患者中显得尤为突出，严重影响患者预后。缺氧是常见的病理生理现象，为应对缺氧，机体可作出相应调节。肾脏是重要的氧感受器，能对机体缺氧做出反应，使肾间质成纤维细胞样细胞合成EPO增加[1]。是以，靶向调节成纤维细胞中低氧诱导因子（Hypoxia inducible factor，HIF）的表达成为改善患者肾性贫血新的治疗策略。本文对血液净化中心1例血液透析合并肾性贫血患者使用HIF-PHI-罗沙司他[生产企业：法博进（中国）医药技术开发有限公司，国药准字：H20180023，H20180024，批准文号：YBH03612018]效果报道如下。……