老年维持性血液透析患者透析间期血压节律的影响因素分析  

Investigation of factors of circadian rhythm of interdialytic ambulatory blood pressure in elderly maintenance hemodialysis patients

作　　者：王莹[1] 牛建英[1] 范伟锋[1] 罗丽红[1] 钱英俊[1] 张绮[1] 顾勇[1] 

机构地区：[1]复旦大学附属上海市第五人民医院肾内科,上海市200240

出　　处：《老年医学与保健》2011年第5期288-292,共5页Geriatrics & Health Care

摘　　要：目的探讨老年维持性血液透析（MHD）患者透析间期动态血压节律的影响因素。方法选择28例老年MHD患者，均于透析间期进行24h动态血压监测，同时完善血液生化指标和心脏超声检查。根据动态血压监测中夜间收缩压下降率情况将患者分为2组：血压节律正常组和血压节律异常组。采用独立样本t检验或Fisher确切概率法比较两组患者一般情况、血液生化指标、动态血压参数、心脏结构及功能的差异；采用多因素Logistic回归分析老年MHD患者透析间期血压节律的影响因素。结果（1）血压节律异常组甲状旁腺激素水平、动态动脉硬化指数、对称性动态动脉硬化指数、左室质量指数高于血压节律正常组（P〈0．05），差异有统计学意义。（2）多因素Logistic回归分析结果显示，甲状旁腺激素、对称性动念动脉硬化指数、左室肥大是动态血压节血律异常的独立危险因素。结论继发性甲状腺机能亢进、动脉硬化、左室肥大是老年MHD患者透析间期动态血压节律异常的独立危险因素。Objective To investigate factors that influence circadian rhythm of interdialytic ambulatory blood pressure in elderly patients with maintenance hemodialysis （MHD）. Methods Ambulatory blood pressure monitoring （ABPM） was conducted in twenty-eight elderly MHD patients between two dialysis sessions. The data of ABPM as well as echocardiography and serum biochemical indicators were examined. Two groups were identified with different ranges of decline rate of nocturnal systolic blood pressure： normal and abnormal blood pressure rhythm groups. Clinical records on epidemiologic, hematological, ABPM and cardiac ultrasonic aspects of the two groups were compared by independent-samples T test or Fisher exact method. Logistic regression model was used to analysis the risk factors influencing circadian rhythm of interdialytic ambulatory blood pressure in elderly MHD patients. Results （1） The mean parathyroid hormone level, ambulatory arterial stiffness index, symmetrical ambulatory arterial stiffness index, left ventricular mass index in the abnormal blood pressure rhythm group were obviously higher than those in the normal group and these differences were statistically significant （P 〈 0.05）. （2） Multivariate Logistic regression proportional analyses showed that parathyroid hormone, symmetrical ambulatory arterial stiftness index, left ventricular hypertrophy were the independent risk factors of circadian rhythm of interdialytic ambulatory blood pressure in the elderly MHD patients. Conclusion Secondary hyperparathyroidism, arterial sclerosis and left ventricular hypertrophy were the independent risk factors influencing nocturnal systolic blood pressure fall and blood pressure rhythm in elderly maintenance hemodialysis patients.

关 键 词：老年 血液透析 动态血压 

分 类 号：R544[医药卫生—心血管疾病]