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(χ2=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)×109/L比(0.43±0.54)×109/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 (χ2=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)×109/L vs. (0.43±0.54)×109/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.
[1] Yang C, Wang H, Zhao X, et al. CKD in China: Evolving Spectrum and Public Health Implications[J]. Am J Kidney Dis. 2020,76(2):258-264.
[2] 张胜男,贾丹,孙平辉,等.肾移植术后并发慢性移植肾失功影响因素分析[J].中华移植杂志(电子版).2021,15(3):147-151.
[3] 中华医学会器官移植学分会,中国医师协会器官移植医师分会.中国肾移植排斥反应临床诊疗指南(2016版)[J].器官移植.2016,7(5):332-338.
[4] 林锦雯,陈江华.再次肾移植受者和移植肾长期预后影响因素分析[J].中华移植杂志（电子版）.2019,13(2):109-113.
[5] Kang GW, Jang MH, Hwang EA, et al. Comparison of peritoneal dialysis and hemodialysis after kidney transplant failure[J]. Transplant Proc. 2013,45(8):2946-2948.
[6] Achinger SG, Ayus JC. When the source of inflammation is hiding in plain sight: Failed kidney transplants, clotted arteriovenous grafts, and central venous catheters[J]. Semin Dial. 2019,32(1):15-21.
[7] Valga F, Monzón T, Henriquez F, et al. Platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios as markers of erythropoietin resistance in chronic haemodialysis patients: a multicentre cross-sectional study[J]. Nefrologia (Engl Ed). 2020,40(3):320-327.
[8] Zhang J, Lu X, Wang S, et al. High Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Are Associated with Poor Survival in Patients with Hemodialysis[J]. Biomed Res Int.2021,2021:9958081.
[9] Xiang F, Chen R, Cao X, et al. Monocyte/lymphocyte ratio as a better predictor of cardiovascular and all-cause mortality in hemodialysis patients: A prospective cohort study[J]. Hemodial Int. 2018,22(1):82-92.
[10] Hildebrand S, Corbett R, Duncan N,et al. Increased prevalence of eosinophilia in a hemodialysis population: Longitudinal and case control studies[J]. Hemodial Int. 2016,20(3):414-420.
[11] de Oliveira Júnior WV, Sabino Ade P, Figueiredo RC, et al. Inflammation and poor response to treatment with erythropoietin in chronic kidney disease. J Bras Nefrol. 2015 Apr-Jun;37(2):255-263.
[12] López-Gómez JM, Pérez-Flores I, Jofré R, et al. Presence of a failed kidney transplant in patients who are on hemodialysis is associated with chronic inflammatory state and erythropoietin resistance[J]. J Am Soc Nephrol. 2004,15(9):2494-2501.
[13] Mehrotra A, Tan JA, Ames SA. "Out of Sight, Out of Mind": The Failed Renal Allograft as a Cause of ESA Resistance[J]. Semin Dial. 2015;28(5):530-532.
