精准医学杂志2025，Vol.40Issue(4)：336-341,6.DOI:10.13362/j.jpmed.202540081
维持性血液透析患者促红细胞生成刺激剂低反应相关影响因素及预测模型的构建
Influencing factors for hyporesponsiveness to erythropoiesis-stimulating agents in patients on mainte-nance hemodialysis and construction of a predictive model
摘要
Abstract
Objective To investigate the influencing factors for hyporesponsiveness to erythropoiesis-stimulating agents(ESAs)in patients on maintenance hemodialysis(MHD),and to construct a predictive model.Methods A total of 120 patients with end-stage chronic kidney disease(CKD)who received MHD and had hyporesponsiveness to ESAs from January 2020 to June 2023 were enrolled as hyporesponsiveness group,and 122 patients without hyporesponsiveness to ESAs who received MHD during the same period of time were enrolled as non-hyporesponsiveness group.Related data were collected for both groups,including sex,age,body height,body weight,primary diseases(chronic glomerulonephritis,chronic renal insufficiency of unknown cause,ne-phrotic syndrome,polycystic kidney,obstructive nephropathy,lupus nephritis,diabetes,and hypertension),duration of dialysis,and frequency of dialysis.Meanwhile,related laboratory markers were collected at 6 months of ESAs treatment,i.e.,serum albu-min,blood calcium,blood phosphorus,serum total cholesterol,serum triglyceride,serum parathyroid hormone,blood uric acid,hemoglobin(Hb),mean corpuscular Hb concentration,mean corpuscular volume,hematocrit,lymphocyte count,and platelet count,and platelet-to-lymphocyte ratio(PLR)was calculated.A multivariate logistic regression analysis was performed for the in-dicators with statistical difference in the univariate analysis,and Python 3.12 was used to plot a nomogram.The receiver operating characteristic(ROC)curve was plotted to assess the value of related indicators in predicting hyporesponsiveness to ESAs in MHD patients.Results The multivariate logistic regression analysis showed that PLR,serum albumin,and triglyceride were influen-cing factors for hyporesponsiveness to ESAs in MHD patients.The predictive model constructed based on the above indicators had a Youden index of 0.319 and an area under the ROC curve of 0.689.The calibration curve showed a good degree of fitting between the actual value and the predictive value,and the decision curve analysis showed a high net benefit in predicting hyporesponsiveness to ESAs in MHD patients within a range of 0.4-0.6 for threshold probability.Conclusion PLR,serum albumin,and triglyce-ride have a certain value in predicting hyporesponsiveness to ESAs in MHD patients.The risk prediction model for hyporesponsiveness to ESAs in MHD patients constructed based on PLR,triglyceride,and albumin has good predictive performance and can provide a basis for predicting hyporesponsiveness to ESAs in MHD patients.关键词
肾透析/贫血/肾功能不全/红细胞生成素/淋巴细胞/中性白细胞/血小板Key words
Renal dialysis/Anemia/Renal insufficiency/Erythropoietin/Lymphocytes/Neutrophils/Blood platelets分类
医药卫生引用本文复制引用
尹佳茗,罗从娟,申兵,袁楠,孙李杰,柴雅琳..维持性血液透析患者促红细胞生成刺激剂低反应相关影响因素及预测模型的构建[J].精准医学杂志,2025,40(4):336-341,6.基金项目
国家自然科学基金项目(81700585,81770-679) （81700585,81770-679）
青岛市科技惠民示范引导专项(20-3-4-36-nsh) （20-3-4-36-nsh）
