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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(χ~2=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将有助于提高患者对Epo的反应性。
Objective To analyze the factors influencing erythropoietin (EPO) reactivity in maintenance hemodialysis (MHD) patients to help improve anemia management. Methods Eighty eligible patients were retrospectively observed for 12 months. Demographic data, dosage of erythropoietin, hemoglobin (HGB), and biochemical parameters were collected. This study used the erythropoietin resistence index (ERI) as an index for assessing erythropoietin responsiveness in patients. ERI = weekly erythropoietin dose / body mass (kg) / hemoglobin (g / dl). Logistic regression analysis of erythropoietin hyporesponsiveness-related factors. Results The average ERI in 80 MHD patients was 16 IU / week / kg / g / dl. 26% of patients were Epo hyporeactivity. The patients were divided into ERI <25 and ERI≥25. The proportion of female patients with ERI≥25 was significantly higher than that of ERI <25 (χ ~ 2 = 3.972, P = 0.046) and hemoglobin (t = 3.123, P = 0.003) and 25 (OH) D levels (t = 2.606, P = 0.011). The levels of BMI and total cholesterol (TC) in ERI≥25 group were also lower than those in ERI group (t = 1.969, P = 0.053). Multivariate logistic regression analysis was used to analyze the relationship between gender, age of dialysis, Kt / V, body mass index (BMI), serum albumin (ALB), serum albumin (ALB) and serum alkaline phosphatase alkaline phosphatase (ALP), 25 (OH) D deficiency was independently associated with low Epo responsivity (HR 4.590, 95% CI 1.277-16.503). Conclusion The incidence of erythropoietin hyporesponsiveness in hemodialysis patients is high. In women, the poor nutritional status correlates with the development of Epo hyporesponsiveness. 25 (OH) D deficiency is an independent and independent correlate of Epo hyporesponsiveness in patients and therefore corrects 25 (OH) D deficiency and improves patient nutritional status Helps to improve patient response to Epo.