中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (02): 128-132.doi: 10.3969/j.issn.1671-4091.2026.02.009

• 临床研究 • 上一篇    下一篇

非透析依赖性慢性肾脏病合并肾性贫血患者红细胞生成素类制剂低反应性预测模型的构建与验证

王焕娟   田祥燕   杨京京   杜民古   

  1. 266300 青岛，青岛市胶州中心医院 1血液净化中心   2肾病风湿免疫科
  • 收稿日期:2025-05-26 修回日期:2025-12-08 出版日期:2026-02-12 发布日期:2026-02-02
  • 通讯作者: 王焕娟 E-mail:tianxy0769@163.com
  • 基金资助:
    2023年度第一批青岛市科技计划项目(21-1-4-rkjk-18-nsh)

Development and validation of a predictive model for renal anemia hyporesponsive to erythropoiesis stimulating agents in patients with chronic kidney disease not dependent on dialysis

WANG Huan-juan, TIAN Xiang- yan, YANG Jing-jing, DU Min- gu   

  1. Centre of Blood Purification, and 2 Department of Nephrology, Rheumatology and Immunology, Qingdao Jiaozhou Central Hospital, Qingdao 266300, China
  • Received:2025-05-26 Revised:2025-12-08 Online:2026-02-12 Published:2026-02-02
  • Contact: 青岛市胶州中心医院1血液净化中心 E-mail:tianxy0769@163.com

摘要： 目的 构建非透析依赖性慢性肾脏病(non-dialysis-dependent chronic kidney disease， NDD-CKD)合并肾性贫血患者红细胞生成素类制剂(erythropoiesis-stimulating agents，ESA)低反应性 的预测模型并验证。 方法 回顾性选取2020年1月—2024年1月青岛市胶州中心医院收治的NDD-CKD 合并肾性贫血患者，所有患者均接受ESA治疗。统计ESA治疗反应性，收集临床资料，应用多因素Logistic回归分析影响NDD-CKD合并肾性贫血患者ESA低反应性的因素，基于Logistic回归结果构建Nomogram预测模型并验证。 结果 共纳入208例患者，其中ESA低反应45例(21.63%)。多因素Logistic回 归 结 果 显 示：高 中 性 粒 细 胞 与 淋 巴 细 胞 比 值(neutrophil/lymphocyte ratio，NLR) (OR=1.614，95%CI：1.063～2.451，P＜0.001)、高 甲 状 旁 腺 激 素(parathyroid hormone，PTH) (OR=1.457，95% CI：1.074～ 1.979，P＜0.001)是NDD-CKD合并肾性贫血患者ESA低反应性的危险因素，高估算肾小球滤过率(estimated glomerular filtration rate，eGFR) (OR=0.547，95%CI：0.314～0.953，P=0.002)、高 血 红 蛋 白 (OR=0.598，95%CI：0.365～0.977，P=0.006)是保护因素。基于危险因素构建的Nomogram预测模型经验 证具有较高的校准度(平均绝对误差为0.006)、预测准确性(曲线下面积为0.922)和临床实用性。 结 论 NDD-CKD合并肾性贫血患者eGFR、血红蛋白、NLR、PTH水平与ESA低反应性有关，基于以上因素构建的 Nomogram预测模型能有效预测ESA低反应性的风险。

关键词: 透析依赖性慢性肾脏病, 红细胞生成素类制剂, 低反应性, Nomogram预测模型

Abstract: Objective To develop and validate a predictive model for renal anemia hyporesponsive to erythropoiesis- stimulating agents (ESA) in patients with chronic kidney disease not dependent on dialysis (NDD-CKD). Methods A retrospective study was conducted on 208 NDD-CKD patients with renal anemia in our hospital from January 2020 to January 2024. They were treated with ESA, and the responsiveness to ESA was assessed. Their clinical data were collected. Multivariate logistic regression was applied to analyze the influencing factors for low ESA reactivity in these patients. A nomogram prediction model for low ESA reactivity was constructed based on the regression results, and value of the nomogram was validated. Results Low ESA reactivity was observed in 45 cases (21.63%). Multivariate logistic regression showed that high neutrophil/lymphocyte ratio (NLR) (OR=1.614, 95% CI:1.063～2.451, P＜0.001) and high parathyroid hormone (PTH) (OR=1.457, 95%CI: 1.074～1.979, P＜0.001) were the risk factors, and higher estimated glomerular filtration rate (eGFR) (OR=0.547, 95% CI: 0.314～0.953, P=0.002) and higher hemoglobin (OR=0.598, 95% CI: 0.365～0.977, P=0.006) were the protective factors for low ESA reactivity in NDD-CKD patients with renal anemia. The nomogram prediction model for low ESA reactivity exhibited higher calibration (average absolute error=0.006), prediction accuracy (area under the curve=0.922) and clinical practicability. Conclusion The levels of eGFR, hemoglobin, NLR, and PTH are correlated with low ESA reactivity in NDD-CKD with renal anemia. The nomogram prediction model constructed based on the risk factors can effectively predict risk of low ESA reactivity in these patients.

Key words: Non-dialysis-dependent chronic kidney disease, Erythropoiesis-stimulating agents, Hyporesponsiveness, Nomogram prediction model

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