中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (02): 115-119.doi: 10.3969/j.issn.1671-4091.2026.02.006

• 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分析

张 月   尹夏艳   刘文虎   

  1. 100050 北京，1 首都医科大学附属北京友谊医院肾脏内科
  • 收稿日期:2025-06-23 修回日期:2025-09-22 出版日期:2026-02-12 发布日期:2026-02-02
  • 通讯作者: 刘文虎 E-mail:wenhuliu@mail.ccmu.edu.cn

Analysis of influencing factors for erythropoietin hypo-responsiveness in maintenance hemodialysis patient

 ZHANG Yue, YIN Xia-yan,  LIU Wen-hu   

  1. Department of Nephrology, Beijing Friendship Hospital,Capital Medical University, Beijing 100050, China
  • Received:2025-06-23 Revised:2025-09-22 Online:2026-02-12 Published:2026-02-02
  • Contact: 100050 北京，1首都医科大学附属北京友谊医院肾脏内科 E-mail:wenhuliu@mail.ccmu.edu.cn

摘要： 目的 维持性血液透析患者常存在红细胞生成素低反应性，导致贫血难以纠正，明确其影响因素对指导临床干预至关重要。 方法 纳入2022年9月—2023年9月于北京友谊医院血液透析中心行维持性血液透析的患者，根据红细胞生成素抵抗指数(erythropoietin resistance index,ERI)中位数将其分为反应性理想组(ERI-T1组)和欠佳组(ERI-T2组)，并进一步分析其人口学及实验室指标对此的影响。 结果 共纳入236例患者，其中ERI-T1组117例，ERI-T2组119例。ERI-T2组的女性占比较ERIT1组高(t=-0.396，P＜0.001)，体质量指数(Z=-2.088，P=0.037)、血红蛋白(Z=-4.067，P＜0.001)、血清铁(Z= -3.087，P=0.002)、转铁蛋白饱和度(Z=-2.216，P=0.027)及白蛋白(Z=-3.226，P=0.001)较ERI-T1组低。相关分析显示血清铁(r=-0.231，P=0.012)、白蛋白(r=-0.186，P=0.043)与ERI呈负相关；多因素线性回归分析显示血清铁(β=-0.269，P=0.003)与白蛋白(β=-0.218，P=0.017)与ERI呈独立负相关。Logistic回归分析显示白蛋白是维持性血液透析患者EPO低反应性的独立保护因素(OR=0.881，95% CI：0.809～0.959，P=0.004)。 结论 低血清铁和低白蛋白是维持性血液透析患者红细胞生成素低反应性的可干预危险因素，白蛋白可作为预测EPO低反应性风险的临床实用指标，临床需关注患者营养状态以优化贫血管理。

关键词: 维持性血液透析, 红细胞生成素低反应性, 红细胞生成素抵抗指数, 白蛋白, 血清铁

Abstract: 【Abstract】bjective Erythropoietin (EPO) hypo-responsiveness is not rare in maintenance hemodialysis (MHD) patients, leading to refractory anemia. Identifying its influencing factors is crucial for guiding clinical intervention. Methods Patients undergoing maintenance hemodialysis at the Hemodialysis Center of Beijing Friendship Hospital from September 2022 to September 2023 were enrolled. Based on the median erythropoietin resistance index (ERI), they were divided into an ideal response group (ERI-T1 group) and a suboptimal response group (ERI-T2 group). The impact of demographic and laboratory indicators on ERI was further analyzed. Results A total of 236 patients were included, with 117 in the ERI-T1 group and 119 in the ERI-T2 group. The proportion of females was higher in the ERI-T2 group compared to the ERI-T1 group (t=-0.396, P＜0.001). Body mass index (Z=-2.088, P=0.037), hemoglobin (Z=-4.067, P＜0.001), serum iron (Z=-3.087, P=0.002), transferrin saturation (Z=- 2.216, P=0.027), and albumin (Z=- 3.226, P=0.001) were lower in the ERI-T2 group than in the ERI-T1 group. Correlation analysis showed that serum iron (r=-0.231, P=0.012) and albumin (r=-0.186, P=0.043) were negatively correlated with ERI. Multivariate linear regression analysis revealed that serum iron (β=-0.269, P=0.003) and albumin (β=-0.218, P=0.017) were independently and negatively correlated with ERI. Logistic regression analysis indicated that albumin was an independent protective factor against EPO hypo- responsiveness in maintenance hemodialysis patients (OR=0.881, 95% CI: 0.809～ 0.959, P=0.004). Conclusions Low serum iron and low albumin are modifiable risk factors for EPO hypo-responsiveness in MHD patients. Albumin can serve as a clinical practical predictive marker for EPO hypo-responsiveness. Clinical attention to patients' nutritional status is necessary to optimize anemia management.

Key words: Maintenance hemodialysis, Erythropoietin hypo- responsiveness, Erythropoietin resistance index, Albumin, Serum iron

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