系统免疫炎症指数与维持性血液透析患者促红细胞生成素低反应性的相关性研究  

Correlation between Systemic Immune-inflammation Index and Erythropoietin Hypo-responsiveness in Patients with Maintenance Hemodialysis

作　　者：牛娣 陈瑞芳 庞欣欣 肖明芝 张峻韶 张效威 NIU Di;CHEN Ruifang;PANG Xinxin;XIAO Mingzhi;ZHANG Junshao;ZHANG Xiaowei(The Second Clinical Medical School,Henan University of Chinese Medicine,Zhengzhou 450046,China;Nephrology Department,Henan Province Hospital of Traditional Chinese Medicine/the Second Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450002,China)

机构地区：[1]河南中医药大学第二临床医学院,河南省郑州市450046 [2]河南省中医院河南中医药大学第二附属医院肾病科,河南省郑州市450002

出　　处：《中国全科医学》2024年第29期3635-3640,共6页Chinese General Practice

基　　金：国家重点研发计划“战略性科技创新合作”重点专项(2020YFE0201800);国家中医临床研究基地科研项目(2022JDZX139);2024年度河南省中医药科学研究专项(2024ZY2075);2024年河南省研究生教育改革与质量提升工程项目(YJS2024KC22)。

摘　　要：背景促红细胞生成素(EPO)低反应性是维持性血液透析(MHD)患者肾性贫血治疗达标率不高的主要原因之一,也是MHD患者死亡的独立危险因素,尽早识别并予以前期干预是改善预后的关键。血液炎性指标可能与MHD患者EPO低反应性存在相关性。目的探究系统免疫炎症指数(SII)与MHD患者EPO低反应性的相关性。方法选取2022年6月—2023年6月于河南省中医院血液透析中心行规律MHD的患者180例为研究对象,使用EPO抵抗指数(ERI)评价患者的EPO反应性,并根据ERI将患者分为EPO低反应组与非EPO低反应组。比较两组患者的一般资料及实验室指标资料;采用Pear_(s)on相关分析及Spearman秩相关分析探讨ERI与各指标的相关性;采用多因素Logistic回归分析探究MHD患者EPO低反应性的独立相关因素;绘制受试者工作特征(ROC)曲线评估SII对MHD患者EPO低反应性的预测价值。结果180例MHD患者中,男104例(57.8%)、女76例(42.2%),年龄(56.1±8.6)岁。EPO低反应组52例(28.9%),非EPO低反应组128例(71.1%)。EPO低反应组与非EPO低反应组透析月龄、透后体质量、每周重组人促红细胞生成素(rHuEPO)用量、白细胞计数、中性粒细胞计数、淋巴细胞计数、红细胞计数、血红蛋白水平、血小板计数、血清白蛋白水平、甲状旁腺激素、三酰甘油、ERI、中性粒细胞-淋巴细胞比(NLR)、血小板-淋巴细胞比(PLR)、SII比较,差异均有统计学意义(P<0.05)。相关性分析结果显示,MHD患者ERI与每周rHuEPO用量、白细胞计数、中性粒细胞计数、血小板计数、血尿酸、血磷、血清铁蛋白、NLR、PLR、SII呈正相关[r(r_(s))=0.486、0.355、0.348、0.294、0.198、0.270、0.167、0.258、0.302、0.317,P<0.05];与透后体质量、红细胞计数、血红蛋白、血清白蛋白呈负相关[r(r_(s))=-0.407、-0.502、-0.627、-0.342,P<0.05]。多因素Logistic回归分析结果显示,SII为MHD患者EPO低反应性的独立相关因素之一(OBackground Erythropoietin(EPO)hypo-responsiveness is one of the main reasons for the low compliance rate of renal anemia in maintenance hemodialysis(MHD)patients,and it is also an independent risk factor for death in MHD patients.Early identification and early intervention is the key to improve prognosis.Blood inflammatory marker_(s) may be associated with EPO hypo-responsiveness in MHD patients.Objective To explore the correlation between systemic immune-inflammation index(SII)and EPO hypo-responsiveness in MHD patients.Methods A total of 180 patients who underwent regular MHD at the hemodialysis center of Henan Province Hospital of Traditional Chinese Medicine from June 2022 to June 2023 were selected as the study objects.EPO resistance index(ERI)was used to evaluate the EPO reactivity of the patients,and they were divided into EPO hypo-responsiveness group and non-EPO hypo-responsiveness group according to the ERI value.The general data and laboratory index data of the two groups were compared.Pear_(s)on correlation analysis and Spearman rank correlation analysis were used to assess the correlation of ERI with other various indicator_(s).Multivariate Logistic regression analysis was used to explore the independent correlation factor_(s) of EPO hypo-responsiveness in MHD patients.The predictive value of SII for EPO hypo-responsiveness in MHD patients was analyzed using receiver operating characteristic(ROC)curves.Results A total of 180 patients with MHD were included,including 104 males(57.8%)and 76 females(42.2%),aged(56.1±8.6)year_(s).There were 52 cases(28.9%)in EPO hypo-responsiveness group and 128 cases(71.1%)in non-EPO hypo-responsiveness group.There were significant differences in dialysis age,post-dialysis body weight,weekly rHuEPO dosage,white blood cells,neutrophils,lymphocytes,red blood cells,hemoglobin,platelets,albumin,parathyroid hormone,triglyceride,ERI,neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR)and SII between EPO hypo-responsiveness group and non-EPO hypo-responsiveness gro

关 键 词：维持性血液透析 促红细胞生成素低反应性 系统免疫炎症指数 相关性分析 

分 类 号：R459.5[医药卫生—治疗学]