中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (03): 149-153.doi: 10.3969/j.issn.1671-4091.2016.03.007

• 临床研究 • 上一篇    下一篇

维持性血液透析患者对红细胞生成素低反应性的影响因素

蒲蕾1,阮一哲1,洪大情1,吴姝焜1,冯韵霖1,杨鸿玲1,邓菲1,何强1,王莉1   

  1. 四川省医学科学院，四川省人民医院肾内科
  • 收稿日期:2015-10-12 修回日期:2015-12-21 出版日期:2016-03-12 发布日期:2016-03-19
  • 通讯作者: 王莉 scwangli62@163.com E-mail:scwangli62@163.com

Factors that contribute to the erythropoietin hyporesponsiveness in patients on maintenance hemodialysis

  • Received:2015-10-12 Revised:2015-12-21 Online:2016-03-12 Published:2016-03-19

RichHTML

2

PDF

334

摘要： 目的分析影响维持性血液透析(maintenance hemodialysis，MHD)患者对红细胞生成素(erythropoietin，EPO)反应性的因素，以帮助改善贫血管理。方法符合条件的80 名患者，回顾性观察12 个月，收集患者人口学资料，红细胞生成素使用剂量、血红蛋白(hemoglobin,HGB)及生化指标等。本研究使用红细胞生成素抵抗指数(erythropoietin resistence index，ERI)作为评价患者对红细胞生成素反应性的指标。ERI=每周红细胞生成素使用剂量/体质量(kg)/血红蛋白(g/dl)。Logistic 回归分析与红细胞生成素低反应性相关的因素。结果80 名MHD 患者ERI 平均值为16IU/周/kg/g/dl。26%的患者为Epo 低反应性。将患者分为ERI＜25 和ERI≥25，与ERI＜25 组相比，ERI≥25 组女性患者的比例显著升高(χ2=3.972，P=0.046)，血红蛋白水平(t=3.123，P=0.003)和25(OH)D 水平(t=2.606，P=0.011)显著下降。ERI≥25 组BMI 和胆固醇(total cholesterol,TC)水平也较ERI＜25 组低(t=1.969，P=0.053)。多元logistic 回归分析，校正性别、透析龄、尿素清除率(Kt/V)、体质量指数(body mass index,BMI)、TC、血清白蛋白(serum albumin,ALB)及血清碱性磷酸酶(serum alkaline phosphatase,ALP)，25(OH)D缺乏与Epo 低反应性有独立相关关系(HR 4.590，95% CI 1.277～16.503)。结论本中心血液透析患者中红细胞生成素低反应性的发生率较高。女性患者，营养状况不良与患者Epo 低反应性的发生有一定相关性，25(OH)D 缺乏是患者Epo 低反应性的独立相关因素，因此纠正25(OH)D 缺乏及改善患者营养状况有助于提高患者对Epo的反应性。

关键词: 血液透析, 贫血, 红细胞生成素, 红细胞生成素抵抗指数

Abstract: Objective This study was carried out to identify the factors that contribute to the erythropoietin hyporesponsiveness in patients on maintenance hemodialysis (MHD). Methods Demographic data, hemoglobin, dose of erythropoietin, biochemical and other related indicators were collected from 80 MHD patients and analyzed retrospectively. They were followed up for 12 months. Erythropoietin resistance index (ERI) calculated by means of dividing the weekly weight (kg) adjusted dose of ESA (IU) by the hemoglobin level (g/dL) was used to evaluate the response to erythropoietin in MHD patients. Logistic regression was used to determine the key variables that might be independently involved in the erythropoietin hyporesponsiveness in MHD patients. Results The mean ERI for the entire study population was 16 IU/kg/week/g/dl, and 20% of the patients had erythropoietin hyporesponsiveness. Patients were them divided into two groups
according to ERI: ERI ＜25 IU/week/kg/g/dl group and ERI ≥25 IU/week/kg/g/dl group. In ERI ≥25 group, the proportion of female was higher (χ2=3.972, P=0.046), and hemoglobin and 25(OH)D were significantly lower than those in ERI ＜25 group (t=3.123 vs. 2.606; P=0.003 vs. 0.011). In addition, body mass index (BMI) and serum cholesterol were lower in ERI ≥25 group than in ERI ＜25 group (t=1.969, P=0.053). Logistic regression demonstrated that adjusted gender, dialysis vintage, BMI, Kt/V, serum cholesterol, serum albumin, alkaline phosphatase, and 25(OH)D deficiency were the independent factors for erythropoietin hyporesponsiveness (HR: 4.590; 95% CI: 1.277～16.503). Conclusion The prevalence of erythropoietin hyporesponsiveness was higher among MHD patients in our hemodialysis center. Female gender and malnutrition correlated to erythropoietin hyporesponsiveness, and 25(OH)D deficiency was the main risk factor for erythropoietin hyporesponsiveness. Improving 25(OH)D deficiency and malnutrition will raise erythropoietin respon siveness in MHD patients.

Key words: hemadialysis, anemia, erythropoietin, erythropoietin resistence index(ERI)