影响维持性血液透析患者促红细胞生成素抵抗的因素分析

Analysis on factors affecting erythropoietin resistance in maintenance hemodialysis patients

目的探讨影响维持性血液透析患者促红细胞生成素(EPO)抵抗的因素。方法以2019年6-12月北京大学第一医院两个血液净化中心,治疗3个月以上的298例血液透析患者为研究对象。记录患者基本情况、血液实验室检测指标、主要诊断及合并症、EPO每周用量并计算EPO抵抗指数(ERI)。对维持性血液透析患者相关数据进行汇总,比较两个透析中心患者变量之间的差异。通过单因素线性回归分析研究各变量与ERI的关系,将单因素分析结果P<0.05的相关因素使用逐步后退法进行多重线性回归分析ERI的影响因素。结果两中心ERI无显著差异,将两个中心患者合并通过单因素线性回归分析,显示ERI与透析龄、性别、EPO用法、血清铁蛋白水平、全段甲状旁腺激素(iPTH)水平、清蛋白水平、C反应蛋白(CRP)水平、是否合并心脑血管疾病存在相关性(P<0.05)。ERI与原发病的单因素线性回归分析发现,ERI与肾小球疾病有相关性(P<0.05),与高血压肾病、糖尿病肾病、肾小管疾病等无相关性。多重线性回归分析结果显示ERI与性别、EPO用法、血清铁蛋白水平、iPTH水平、CRP水平存在相关性(P<0.05),而与透析龄、清蛋白水平、是否合并心脑血管疾病及原发病肾小球疾病无相关性。结论EPO抵抗与性别、EPO用法、血清铁蛋白水平、iPTH水平、CRP水平存在相关性。

Objective To investigate the factors influencing the erythropoietin(EPO)resistance in maintenance hemodialysis patients.Methods A total of 298 hemodialysis patients treated for over 3 months in the two blood purification centers of Peking University First Hospital from June 2019 to December 2019 served as the research subjects.The patient′s basic condition,blood laboratory test indexes,main diagnosis and complications and weekly dose of EPO were recorded and the EPO resistance index(ERI)was calculated.The related data of maintenance hemodialysis patients were collected,and the differences between the variables were compared between two hemodialysis centers.The univariate linear regression analysis was used to study the relationship between each variable and ERI,and the correlation factors with P<0.05 in the results of univariate correlation analysis were included by the stepwise regression method and the influencing factors of ERI were analyzed by the multiple linear regression.Results There was no significant difference in ERI between the two centers.The patients from the two centers were combined to conduct the single factor regression analysis,the results showed that ERI was correlated with the dialysis age,sex,usage of EPO,serum ferritin level,iPTH level,albumin level,CRP level and whether complicating cardiac cerebrovascular disease(P<0.05).The single factor regression analysis between ERI and primary disease showed that ERI was correlated with glomerular disease(P<0.05),but was not correlated with hypertensive nephropathy,diabetic nephropathy and renal tubular disease.The multiple linear regression analysis results showed that ERI was correlated with the gender,usage of EPO,serum ferritin level,iPTH level and CRP level(P<0.05),and had no correlation with the dialysis age,albumin,whether complicating cardiac cerebrovascular disease and primary glomerulopathy.Conclusion The EPO resistance has the correlation with the sex,usage of EPO,serum ferritin level,iPTH level and CRP level.