首页|低氧诱导因子脯氨酰羟化酶抑制剂对腹膜透析患者感染事件的影响研究

低氧诱导因子脯氨酰羟化酶抑制剂对腹膜透析患者感染事件的影响研究

Hypoxia-inducible factor prolyl hydroxylase inhibitor on the effect of infection events in patients with peritoneal dialysis

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目的 回顾性分析低氧诱导因子脯氨酰羟化酶抑制剂——罗沙司他对腹膜透析(PD)患者发生感染事件的影响.方法 选取2019年8月至2022年8月于北京大学国际医院肾内科腹膜透析中心行维持性PD治疗的患者126例,按治疗药物分为重组人促红细胞生成素(rHuEPO)组(59例)和罗沙司他组(67例).比较两组患者血红蛋白(Hb)、C反应蛋白、铁代谢等临床指标及感染发生的情况.结果 74例患者共发生90例次感染事件,总感染发生率58.7%.其中腹膜透析相关腹膜炎、腹膜透析导管外口和(或)隧道感染共45例次,占50.0%,呼吸道感染35例次,占38.9%.按照每1000患者月发生感染次数计算累计感染率,rHuEPO组和罗沙司他组的总累计感染率分别是31.1次/1000患者月、38.2次/1000患者月,两组比较差异无统计学意义(P>0.05).rHuEPO组和罗沙司他组PD通路相关感染率(18.7次/1000患者月比14.3次/1000患者月,P=0.461)和呼吸道感染率(10.6次/1000患者月比17.2次/1000患者月,P=0.323),差异均无统计学意义.Cox比例风险回归分析显示,与rHuEPO组相比,校正年龄和透析龄后罗沙司他组总感染风险差异无统计学意义(HR1.07,95%CI0.65~1.76).Kaplan-Meier曲线分析发现,罗沙司他组与rHuEPO组PD通路相关感染的累计发生率差异无统计学意义(P=0.270).罗沙司他组的感染时总铁结合力和不饱和铁结合力高于rHuEPO组,差异有统计学意义(P<0.05).结论 与rHuEPO相比,罗沙司他在治疗贫血过程中未增加PD患者感染的风险.
Objective To retrospectively analyze the impact of the low oxygen inducible factor-prolyl hydroxylase inhibitor—Roxadustat on infection events in peritoneal dialysis(PD)patients.Methods Totally 126 patients receiving maintenance PD treatment at Peritoneal Dialysis Center,Department of Nephrology,Peking University International Hospital from August 2019 to August 2022 were selected and divided into recombinant human erythropoietin(rHuEPO)group(59 cases)and Roxadustat group(67 cases)according to treatment drugs.The clinical indexes such as hemoglobin(Hb),C-reactive protein,iron metabolism and the incidence of infection were compared between the two groups.Results 90 infection events occurred in 74 patients,with a total infection rate of 58.7%.There were 45 cases(50.0%)of peritoneal dialysis-related peritonitis,exit site of peritoneal dialysis catheter and(or)tunnel infection,35 cases(38.9%)of respiratory tract infection.According to the cumulative infection rate per 1000 patient months,the total cumulative infection rate of rHuEPO group and Roxadustat group was 31.1 times per 1000 patient months and 38.2 times per 1000 patient months,respectively,with no statistical significance between the two groups(P>0.05).The rate of PD catheter-related infection(18.7 times per 1000 patient months vs.14.3 times per 1000 patient months,P=0.461)and respiratory tract infection(10.6 times per 1000 patient months vs.17.2 times per 1000 patient months,P=0.323)in the rHuEPO and Roxadustat group,and there were no significantly differences between the two groups.Cox proportional hazards regression analysis showed that there was no statistically difference in total risk of infection between the Roxadustat group and the rHuEPO group after adjusting for age and dialysis age(HR 1.07,95%CI 0.65-1.76).Kaplan-Meier curve analysis showed that there was no significant difference in the cumulative incidence of PD pathway-related infections between the Roxadustat group and the rHuEPO group(P=0.270).The total iron binding capacity and unsaturated iron binding capacity in Roxadustat group were higher than those in rHuEPO group,and the difference was statistically significant(P<0.05).Conclusion Compared with rHuEPO,Roxadustat does not increase the risk of infection in PD patients during the treatment of anemia.

peritoneal dialysisanemiaRoxadustatrecombinant human erythropoietininfection

丁嘉祥、任晓英、方晓完、王梅、杨清华

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北京大学国际医院肾内科腹膜透析中心,北京 102206

腹膜透析 贫血 罗沙司他 重组人促红细胞生成素 感染

北京大学国际医院院内科研基金中国健康促进基金会医疗服务能力建设专项基金之"慧研卓识"期刊战略合作项目

YN2021ZD01

2024

中国实用内科杂志
中国医师协会,中国实用医学杂志社

中国实用内科杂志

CSTPCD北大核心
影响因子:1.618
ISSN:1005-2194
年,卷(期):2024.44(1)
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