中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (10): 803-807.doi: 10.3969/j.issn.1671-4091.2025.10.003

• 临床研究 • 上一篇    下一篇

血维生素D及中性粒细胞与淋巴细胞比值水平与维持性血液透析患者红细胞生成素低反应性的关系研究

王丽虹  胡兰芳   

  1. 215101 苏州，1苏州市中西医结合医院血液透析中心
  • 收稿日期:2024-11-19 修回日期:2025-07-03 出版日期:2025-10-12 发布日期:2025-10-12
  • 通讯作者: 胡兰芳 E-mail:hulanfang343@163.com
  • 基金资助:
    苏州市中西医结合医院院级课题(YJ2023003)

A study on the relationship between blood vitamin D and NLR levels with erythropoietin hypo-responsiveness in maintenance hemodialysis patients

WANG Li -hong, HU Lan-fang   

  1. Center of Hemodialysis, Suzhou Integrated Traditional Chinese and Western Medicine Hospital, Suzhou 215101, China
  • Received:2024-11-19 Revised:2025-07-03 Online:2025-10-12 Published:2025-10-12
  • Contact: 215101 苏州，1苏州市中西医结合医院血液透析中心 E-mail:hulanfang343@163.com

摘要： 目的  分析血维生素D及中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)与维持性血液透析(maintenance hemodialysis,MHD)红细胞生成素(erythropoietin,EPO)低反应性的关系。 方法  回顾苏州市中西医结合医院行MHD160例的临床资料。分析血维生素D、NLR预测EPO低反应性效能及剂量-效应关系。 结果  与非EPO低反应组比较，EPO低反应组25(OH)D(t=7.671，P＜0.001)、血红蛋白(t=8.601，P＜0.001)更低，透析龄、每周重组人红细胞生成素(recombinant Human Erythropoietin, rhuEPO)用量、甲状腺旁腺激素、C反应蛋白(c-reactive protein,CRP)、NLR更高(t=2.153，P=0.033、t=12.685，P＜0.001、t=3.330，P=0.001、t=3.004，P=0.003、t=4.148，P＜0.001)；Logistic分析显示：透析龄、NLR、甲状旁腺激素是EPO低反应性的危险因素(OR=1.813，95% CI：1.354～2.272、OR=2.724，95% CI：2.379～3.068、OR=1.416，95% CI：1.001～2.246，P均＜0.001)，25(OH)D是保护因素(OR=0.413，95% CI：0.404～2.379，P＜0.001)；受试者工作特征(receiver operating characteristics,ROC)曲线显示25(OH)D、NLR联合预测曲线下面积为0.920，联合预测效能更高(95% CI：0.859～0.960，P=0.005)。25(OH)D及NLR与EPO低反应性存在非线性剂量-反应关系。 结论  25(OH)D、NLR联合预测EPO低反应性效能高，且两者存在“剂量-反应”关系。

关键词: 维持性血液透析, 血维生素D, 中性粒细胞与淋巴细胞比值, 红细胞生成素, 低反应性

Abstract: Objective  To analyze the relationship between blood vitamin D levels, neutrophil-to-lymphocyte ratio (NLR), and erythropoietin (EPO) hypo-responsiveness in patients undergoing maintenance hemodialysis (MHD).  Methods  The clinical data of 160 patients who underwent MHD in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine were reviewed.  The efficacy of blood vitamin D and NLR in predicting EPO hypo-responsiveness and their dose-response relationship were evaluated.  Results  Compared with the non-EPO hypo-responsive group, the EPO hypo-responsive group had significantly lower 25(OH)D (t =7.671, P<0.001) and hemoglobin levels (t=8.601, P<0.001), and significantly longer dialysis vintage, higher weekly recombinant human erythropoietin (rhuEPO) dosage, higher parathyroid hormone, C-reactive protein (CRP), and NLR levels (t=2.153, P=0.033; t=12.685, P<0.001; t=3.330, P=0.001; t=3.004, P= 0.003; t=4.148, P<0.001). Logistic regression analysis showed that dialysis vintage, NLR, and parathyroid hormone were risk factors for EPO hypo-responsiveness (OR=1.813, 95% CI： 1.354～2.272; OR=2.724, 95% CI ：2.379～3.068; OR=1.416, 95% CI ：1.001～2.246; all P<0.001), while 25(OH)D was a protective factor (OR =0.413, 95% CI：0.404～2.379, P<0.001). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the combined prediction of 25(OH)D and NLR was 0.920, indicating higher predictive efficacy (95% CI ：0.859～0.960, P = 0.005). A nonlinear dose-response relationship was observed between 25(OH)D, NLR, and EPO hypo-responsiveness.  Conclusion  The combination of 25(OH)D and NLR demonstrates high predictive efficacy for EPO hypo-responsiveness, and a dose-response relationship exists between them.

Key words: Maintenance hemodialysis, Blood vitamin D, Neutrophil/lymphocyte ratio, Erythropoietin, Hypo-responsiveness

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