腹膜透析患者红细胞生成素低反应的影响因素及其预测价值

目的 分析影响腹膜透析患者红细胞生成素（EPO）治疗反应的因素，并建立回归模型。 方法 114例腹膜透析患者根据每周EPO剂量分为低反应组、正常反应组和高反应组。收集患者临床资料，检测营养及炎性反应指标，进行直线相关和Ordinal等级回归分析。 结果 与高反应组及正常反应组比较， EPO低反应组血红蛋白（78.11±13.42）比（106.28±23.83）、（96.31±12.33） g/L]、血清白蛋白（33.98±4.78）比（39.72±4.26）、（35.76±4.88） g/L]水平下降，C反应蛋白（CRP）（26.08±21.66） 比（5.46±1.75）、（11.82±5.63） mg/L]、血清铁蛋白（371.08±89.38）比（289.39±76.84）、（323.07±62.46） μg/L]水平升高，差异均有统计学意义 (均P < 0.01)。相关回归分析显示，CRP、血清白蛋白及铁蛋白是EPO治疗反应的显著影响因素(P < 0.05)。根据这些因素建立数学模型，血清白蛋白<30 g/L对EPO治疗低反应的影响最大，高血清铁蛋白、高CRP的影响次之。 结论 血清白蛋白、CRP和铁蛋白水平与EPO治疗反应相关。炎性反应状态和营养不良是导致EPO低反应的主要原因。

Influencing factors of erythropoietin hyporesponsiveness in patients on maintenance peritoneal dialysis and their prognostic value

Objective To investigate the factors associated with hyporesponsiveness to erythropoietin (EPO) in patients on maintenance peritoneal dialysis (PD) . Methods Data of 114 PD patients in our PD center were collected . Patients were divided into three groups according to weekly EPO dose: hyperresponsive, hyporesponsive and normal responsive . Various factors were compared among three groups by linear correlation and ordinal regression analysis to predict EPO resistance . Results As compared to hyperresponsive and normal responsive groups,significantly lower serum hemoglobin (78 .11±13 .42) vs (106 .28±23 .83), (96 .31±12 .33) g/L],albumin (33 .98±4 .78) vs (39 .72±4 .26), (35 .76±4 .88) g/L], and significantly higher serum CRP (26 .08±21 .66) vs (5 .46±1 .75), (11 .82±5 .63) mg/L], ferritin (371 .08±89 .38) vs (289 .39±76 .84),(323 .07±62 .46) μg/L] were found in hyporesponsive group(all P ＜ 0 .01) . Erythropoietin resistance index (ERI) was correlated with CRP and albumin . Regression analysis showed that serum albumin,CRP and ferritin were strong predictors of EPO hyporespnsiveness . Conclusions Serum albumin,CRP and ferritin are closely related to hyporesponsiveness . Malnutrition and inflammatory state contribute to EPO hyporesponsiveness .