血液透析患者红细胞生成素反应性影响因素的相关分析  

Correlation analysis on the influencing factors for erythropoietin responsiveness in hemodialysis patients

作　　者：俞卫红 熊浩 宋杰 袁芳[1] YU Wei-hong;XIONG Hao;SONG Jie;YUAN Fang(Department of Nephrology,Institution of Nephrology,Second Xiangya Hospital of Central South University,Hunan Provincial Key Laboratory of Nephrology and Blood Purification,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院肾内科,中南大学湘雅二医院肾脏病研究所湖南省肾脏病与血液净化重点实验室,长沙410011

出　　处：《中国血液净化》2022年第11期818-822,共5页Chinese Journal of Blood Purification

基　　金：国家自然科学基金(81770730);湖南省自然科学基金(2017JJ2352)。

摘　　要：目的探讨血液透析患者红细胞生成素反应性的影响因素。方法选择2021年1月1日~2021年7月31日在中南大学湘雅二医院血液净化中心规律血液透析患者,收集临床资料及实验室检查结果等。分别根据红细胞生成素抵抗指数(erythropoietin resistance index,ERI)的四分位数、第三四分位数进行分组,根据体质量指数(body mass index,BMI)分组,比较组间差异;使用Logistic回归分析患者红细胞生成素反应性的影响因素。利用ROC曲线评估参数对ERI的预测性能。结果与高ERI组相比,低ERI组BMI、血红蛋白水平更高(t值分别为2.896、4.246,P值分别为0.004、<0.001),而白细胞介素6(interleukin-6,IL-6)、每周使用红细胞生成刺激剂(erythropoiesis-stimulating agents,ESAs)剂量更低(Z值分别为-2.738、-8.820,P值分别为0.006、<0.001)。Logistic回归分析显示:BMI(OR=0.844,95%CI:0.740~0.963,P=0.012)、IL-6(OR=1.119,95%CI:1.031~1.215,P=0.007)是维持性血液透析患者红细胞生成素反应性的独立危险因素。工作特征曲线发现BMI对辅助预测ERI指导作用最高。与低体质量指数和体质量指数正常组相比,超重组患者ERI和ESAs剂量更小(K值分别为15.015、16.937,P值分别为0.001、<0.001)。结论BMI、IL-6是影响维持性血液透析患者红细胞生成素反应性的独立危险因素;BMI可能具有辅助诊断预测ERI的指导作用。Objective To investigate the influencing factors for erythropoietin responsiveness in hemodialysis patients.Methods Patients with regular hemodialysis in the Hemodialysis Purification Center,the Second Xiangya Hospital of Central South University from January 1st,2021 to July 31st,2021 were recruited.Their clinical data were collected.According to the quartile and third quartile of erythropoietin resistance index(ERI),patients were divided into groups for comparison.The influencing factors for erythropoietin responsiveness were analyzed by logistic regression.Patients were further divided into groups according to body mass index(BMI),and the parameters were compared between the groups.ROC curve was used to evaluate the parameters for the predictive performance of ERI.Results BMI and hemoglobin were higher(t=2.896 and 4.246,respectively;P=0.004 and<0.001,respectively),while interleukin-6(IL-6)and weekly doses of erythropoiesis-stimulating agents were lower(Z=-2.738 and-8.820,respectively;P=0.006 and<0.001,respectively)in the lower ERI group,as compare with those in the higher ERI group.Logistic regression showed that BMI(OR=0.844,95%CI:0.740~0.963,P=0.012)and IL-6(OR=1.119,95%CI:1.031~1.215,P=0.007)were the independent risk factors for erythropoietin responsiveness in maintenance hemodialysis patients.The working characteristic curve showed that BMI had the greatest guiding and assistant effects on prediction of ERI.Overweight patients had lower ERI and erythropoiesis-stimulating agent doses(K=15.015 and 16.937,respectively;P=0.001 and<0.001,respectively),as compared with those in the low and the normal BMI groups.Conclusions BMI and IL-6 are the independent risk factors for erythropoietin responsiveness in maintenance hemodialysis patients.BMI may have guiding and assistant roles in the diagnosis and prediction of ERI.

关 键 词：维持性血液透析 贫血 红细胞生成素抵抗指数 体质量指数 白细胞介素-6 

分 类 号：R459.5[医药卫生—治疗学]