移植肾失功的维持性血液透析患者炎症状态与贫血关系的研究

The relationship between inflammatory state and anemia in maintenance hemodialysis patients with renal allograft failure

目的观察移植肾失功(kidney transplant failure,KTF)的维持性血液透析患者的炎症及贫血指标,为改善治疗效果提供临床依据。方法选取北京友谊医院移植肾失功的维持性血液透析患者(KTF组)54例及未进行过肾移植的等量血液透析患者(对照组)作为对照,记录患者的一般信息、血细胞计数检查结果、红细胞生成素(erythropoietin,EPO)使用情况等,计算中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR),血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR),淋巴细胞与单核细胞比值(lymphocyte to monocyte ratio,LMR)及红细胞生成素抵抗指数(erythropoietin resistance index,ERI)等指标,建立数据库并进行统计分析。结果2组患者在年龄(t=-1.095,P=0.276)、性别构成(χ^(2)=0.983,P=0.321)、透析龄(t=1.634,P=0.105)方面无统计学差异。KTF组与对照组的嗜酸性粒细胞数[(0.21±0.21)×10^(9)/L比(0.43±0.54)×10^(9)/L,t=-2.639,P=0.010]、NLR[(4.14±1.92)比(3.47±1.18),t=2.156,P=0.033]、LMR[(2.78±0.80)比(3.51±1.18),t=-3.794,P=0.005]比较,差异有统计学意义。2组患者的EPO用量比较差异无统计学意义(Z=-1.611,P=0.107),KTF组的中位ERI为13.59(7.21,20.37),高于对照组的9.12(5.75,13.48),差异有统计学意义(Z=-2.515,P=0.012)。ERI与PLR呈正相关(r=0.247,P=0.010),与LMR呈负相关(r=-0.217,P=0.024)。结论KTF血液透析患者具有更强的炎症状态,可能是导致EPO抵抗的影响因素之一。

Objective To observe the indexes of inflammation and anemia in maintenance hemodialysis patients with kidney transplant failure(KTF),and to provide clinical basis for improving the therapeutic effect.Methods Fifty-four maintenance hemodialysis patients with kidney transplant failure were included in Beijing Friendship Hospital and other fifty-four hemodialysis patients who had not undergone kidney transplantation were selected as controls.The demographic data of the patients,the results of blood cell counts,the dosage of erythropoietin(EPO)were recorded,and neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),lymphocyte to monocyte ratio(LMR)and EPO resistance index was calculated,and the setup of patients’databases for statistical analysis of the clinical data.Results There was no significant difference in age(t=-1.095,P=0.276),gender(χ^(2)=0.983,P=0.321),and the duration of dialysis(t=1.634,P=0.105)between the two groups.There was significant difference in the number of eosinophils[(0.21±0.21)×10^(9)/L vs.(0.43±0.54)×10^(9)/L,t=-2.639,P=0.010],NLR[(4.14±1.92)vs.(3.47±1.18),t=2.156,P=0.033],LMR[(2.78±0.80)vs.(3.51±1.18),t=-3.794,P=0.005]between the two groups.There was no statistical difference in the dosage of EPO between the two groups(Z=-1.611,P=0.107).The median ERI of the KTF group was 13.59(7.21,20.37),which was higher than that of the control group,which was 9.12(5.75,13.48),and the difference was statistically significant(Z=-2.515,P=0.012).The patients’ERI was positively correlated with PLR(r=0.247,P=0.010),and negatively correlated with LMR(r=-0.217,P=0.024),which was statistically significant.Conclusion Hemodialysis patients with kidney transplant failure have a hyper-inflammatory state,which may be one of the influence factors leading to EPO resistance.