秦迎来,黄彩鸾,陈新焕

目的：评估影响慢性肾病贫血患者蔗糖铁治疗效果影响因素，为临床用药提供指导。方法：研究对象及分组：纳入2023年1月1日至10月30日北京应急总医院80例3~5期非血透依赖型CKD贫血患者，均接受蔗糖铁治疗，随访8周。根据血红蛋白水平变化分为治疗有效组（51例）和无效组（29例）。评估患者铁代谢指标（血清铁蛋白、转铁蛋白饱和度）、炎症标志物（IL-6、CRP等）及肾功能指标的变化，分析铁状态及炎症因子对治疗效果的影响。单因素与多变量logistic回归分析用于筛选独立影响因素，并构建疗效预测模型。结果：临床回顾性研究：疗效及分组差异：总有效率为63.75%。多变量logistic回归分析确认IL-6、铁状态、CRP和PLR为独立影响因素。AUC分别为0.744、0.705、0.733和0.805，联合预测AUC达到0.893（95%CI 0.822-0.964），灵敏度78.6%，特异度86.6%，模型预测值最佳阈值为0.1939。结论：IL-6、铁状态、CRP及PLR是影响蔗糖铁疗效的独立因素。

慢性肾脏病；肾性贫血；炎症因子；白细胞介素-6；蔗糖铁

[1] GBD Chronic Kidney Disease Collaboration.Global,regional,and national burden of chronic kidney disease,1990-2017:a systematic analysis for the Global Burden of Disease Study 2017[J].The Lancet,2020,395(10225):709-733. [2] Thorp M L,Johnson E S,Yang X,et al.Effect of anaemia on mortality,cardiovascular hospitalizations and end-stage renal disease among patients with chronic kidney disease[J].Nephrology (Carlton),2009,14(2):240-246. [3] Gluba-Brzózka A,Franczyk B,Olszewski R,et al.The Influence of Inflammation on Anemia in CKD Patients[J].Int J Mol Sci.2020 Jan 22;21(3):725. [4] Beguin Y,Jaspers A.Iron sucrose-characteristics,efficacy and regulatory aspects of an established treatment of iron deficiency and iron-deficiency anemia in a broad range of therapeutic areas.Expert Opin Pharmacother.2014 Oct;15(14):2087-103. [5] KDOQI.KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease:2007 update of hemoglobin target.Am J Kidney Dis.2007 Sep;50(3):471-530. [6] Malyszko J,Malyszko JS,Matuszkiewicz-Rowinska J.Hepcidin as a therapeutic target for anemia and inflammation associated with chronic kidney disease[J].Expert Opin Ther Targets.2019 May;23(5):407-421. [7] Marques O,Weiss G,Muckenthaler MU.The role of iron in chronic inflammatory diseases:from mechanisms to treatment options in anemia of inflammation[J].Blood.2022 Nov 10;140(19):2011-2023. [8] Thapa BK,Bhatia P,Meena J,et al.Prevalence and risk factors for functional iron deficiency in children with chronic kidney disease.Clin Exp Nephrol.2023 Jan;27(1):66-71. [9] Gluba-Brzózka A,Franczyk B,Olszewski R,et al.The Influence of Inflammation on Anemia in CKD Patients.Int J Mol Sci.2020 Jan 22;21(3):725. [10] Rostoker,G.,F.Lepeytre,J.Rottembourg.Inflammation,Serum Iron,and Risk of Mortality and Cardiovascular Events in Nondialysis CKD Patients.J Am Soc Nephrol,2022.33(3):p.654-655.

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