目的 探讨罗沙司他联合基础疗法治疗原发性肾病综合征(PNS)继发急性肾损伤(AKI)患者的临床效果,以期为PNS继发AKI患者临床治疗方案的选择提供参考.方法 选取2022年7月—2023年5月重庆大学附属中心医院收治的118例PNS继发AKI患者,采用随机数字表法分为对照组和研究组,每组59例.对照组患者采用基础疗法治疗,研究组患者在对照组基础上联合罗沙司他治疗.比较2组患者的临床疗效,治疗前后的肾功能指标[血清肌酐(SCr)、尿素氮(BUN)、肾小球滤过率(eGFR)]、24 h尿蛋白定量(24 h Upro)、血浆白蛋白、血脂指标[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、血常规指标[白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白(Hb)、血小板计数(PLT)]及肝功能指标[白蛋白(ALB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)],并进行安全性评估.结果 研究组患者的治疗总有效率为91.53％(54/59),高于对照组的77.97％(46/59),差异有统计学意义(x2=4.196,P=0.041).2组患者不同治疗时间点的血清SCr、BUN水平及eGFR重复测量方差分析的组间、时间及交互效应比较,差异均有统计学意义(P<0.05);研究组患者治疗7 d、14 d及28 d时的SCr、BUN水平均低于同一时间点的对照组,eGFR高于同一时间点的对照组,差异均有统计学意义(P<0.05).2组患者不同治疗时间点的24 h Upro、血浆白蛋白、TC及TG水平重复测量方差分析的组间、时间及交互效应比较,差异均有统计学意义(P<0.05);研究组患者治疗14 d及28 d时的24 h Upro、TC与TG水平均低于同一时间点的对照组,血浆白蛋白水平高于同一时间点的对照组(P<0.05);2组患者治疗前后LDL-C及HDL-C水平比较,差异无统计学意义(P>0.05).2组患者治疗前及治疗28 d时的WBC、RBC、Hb、PLT、ALB、ALT、AST、TBIL水平比较,差异均无统计学意义(P>0.05).研究组与对照组患者不良反应发生率分别为3.39％(2/59)和1.69％(1/59),差异无统计学意义(P>0.05).结论 罗沙司他联合基础疗法治疗PNS继发AKI患者的疗效确切,能有效改善患者肾功能与血脂代谢,具有较高的用药安全性,且对患者肝功能影响较小,值得在临床推广.
Clinical effect of Roxadustat combined with basic therapy on patients with primary nephrotic syndrome complicated by acute kidney injury
Objective To investigate the clinical effect of Roxadustat combined with basic therapy on patients with acute kid-ney injury(AKI) secondary co primary nephrotic syndrome(PNS)clinicaltherapy,providing a reference for therapy.Methods A total of 118 PNS patients with AKI treated between July 2022 and May 2023 were randomly assigned to control (basic therapy) or study (basic therapy plus Roxadustat) groups,59 patients in each group.The clinical effect,renal function indi-cators[serum creatinine (SCr),blood urea nitrogen (BUN),estimated glomerular filtration rate (eGFR)],24-hour urinary protein (24 h Upro),plasma albumin,blood lipid indicators[triglycerides (TG),total cholesterol (TC),low-density lipo-protein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C)],blood routine indices[white blood cells count (WBC),red blood cells count(RBC),hemoglobin (Hb),platelet count (PLT)],liver function indicators[albumin (ALB),alanine aminotransferase (ALT),aspartate aminotransferase (AST),and total bilirubin (TBIL)]before and after treatment were compared,followed by safety assessment.Results The overall response rate in the study group was significantly high-er than that in the control group[91.53％ (54/59) vs.77.97％ (46/59);x2=4.196,P=0.041].Analysis of variance showed significant differences in SCr,BUN,and eGFR between the two groups over different time points,and interactive effects with statistical significance were also identified (P<0.05).At 7,14,and 28 days,the study group had significantly lower SCr and BUN levels and higher eGFR than the control group (P<0.05).Significant differences were also observed in 24 h Upro,TC,and TG between groups over time (P<0.05).At 14 and 28 days,the study group had significantly lower 24 h Upro,TC,and TG levels and higher plasma albumin levels compared to the control group (P<0.05).No significant differences were found in LDL-C or HDL-C levels before and after treatment between the two groups (P>0.05).Addition-ally,there were no significant differences in WBC,RBC,Hb,PLT,ALB,ALT,AST,TBIL levels before and 28 days af-ter treatment between the two groups (P>0.05).The incidence of adverse reactions was 3.39％ (2/59) in the study group and 1.69％ (1/59) in the control group,with no significant difference (P>0.05).Conclusion Roxadustat combined with basic therapy effectively promotes renal function and lipid metabolism in PNS patients with AKI,with high medication safe-ty and minimal impact on liver function,suggesting clinical applicability.
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