维持性血液透析患者透析前碳酸氢盐浓度与临床特征的关系  

The relationship between predialysis bicarbonate concentration and clinical characteristics in maintenance hemodialysis patients

作　　者：鲁嘉越[1] 朱旻霞[1] 张伟明[1] 蔡宏[1] 朱铭力[2] 倪兆慧[2] 

机构地区：[1]上海交通大学医学院附属仁济医院南院肾脏科,上海201114 [2]上海交通大学医学院附属仁济医院肾脏科,上海200127

出　　处：《中国血液净化》2017年第2期104-107,共4页Chinese Journal of Blood Purification

基　　金：上海交通大学医学院附属仁济医院南院临床学科创新共建平台建设项目(2014MDT02)

摘　　要：目的探讨维持性血液透析患者透前碳酸氢盐浓度与临床特征之间的关系。方法选取上海市仁济南院维持性血液透析患者291例,采集基本透析资料,并于透析间隔最长的透析日进行常规血液生化检查。根据透析前碳酸氢盐浓度平均值以四分位法将患者分为4组,比较不同透析前碳酸氢盐浓度分层对上述临床指标的影响。并以透析前碳酸氢盐浓度为因变量,采用Pearson相关性分析,探讨其与上述临床指标的关系。其中计量资料采取ANOVA方差分析,计数资料采取卡方检验,以P<0.05为有统计学差异。结果不同透析前碳酸氢盐浓度分组在透析龄(F=3.527,P=0.015)、每周2次透析比例(χ2=3.527,P=0.015)、体质量指数(body mass index,BMI)(F=5.000,P=0.002)、血清白蛋白(F=7.336,P<0.001)、透析前血肌酐(F=4.932,P=0.002)、血钙(F=2.969,P=0.032)、血磷(F=13.468,P<0.001)这些指标上存在差异。Pearson相关性分析结果显示,血液透析患者透析前碳酸氢盐浓度与透析龄(r=-0.118,P=0.022)、体质量指数(body mass index,BMI)(r=-0.153,P=0.004)、血清白蛋白(r=-0.285,P<0.001)、透前血肌酐(r=-0.213,P<0.001)、血磷(r=-0.378,P<0.001)、全段甲状旁腺激素(r=-0.129,P=0.014)呈负相关,与血钙(r=0.113,P=0.027)呈正相关。结论血液透析患者在溶质清除稳定及平均血红蛋白浓度达标且无差异的情况下,透析前碳酸氢盐浓度较低的患者具有透析龄长、每周2次透析比例高、BMI较大、血浆白蛋白和透前肌酐较高、以及低钙高磷的特点。Objective To explore the relationship between predialysis bicarbonate concentration and clinical characteristics in maintenance hemodialysis （MHD） patients. Methods A total of 291 MHD patients treated in our dialysis center were enrolled in this study. Their dialysis data and routine blood tests were collected. Patients were assigned into 4 groups according to the average bicarbonate concentration before dialysis by a quartile method, and clinical characteristics were then compared among the 4 groups. Pearson＇s correlation analysis was used to explore the relationship between predialysis bicarbonate concentration and clinical indicators, using predialysis bicarbonate concentrations as the dependent variables. Analysis of variance （ANOVA） was used for the analyses of measurement data, and chi square test was used for the analyses of count data. P〈0.05 was considered to be statistically significant. Results There were differences among the 4 groups in duration of dialysis （F=3.527, P=0.015）, ratio of twice weekly dialysis （X2=3.527, P=0.015）, body mass index （BMI） （F=5.000, P=0.002）, serum albumin （F=7.336, P〈 0.001）, serum creatinine （F=4.932, P=0.002）, serum calcium （F=2.969, P=0.032）, and serum phosphorus （F=13.468, P〈 0.001）. Pearson＇s correlation analyses demonstrated that predialysis bicarbonate concentration was negatively correlated with duration of dialysis （r=-0.118, P=-0.022）, BMI （r=-0.153, P=0.004）, serum albumin （r=-0.285, P〈0.001）, serum creatinine （r=-0.213, P〈0.001）, serum phosphorus （r=-0.378, P〈 0.001 ）, and iPTH （r=-0.129, P=0.014）, and was positively correlated with serum calcium （r=0.113, P= 0.027） in these MHD patients. Conclusions In MHD patients with stable clearance of solution and simi- lar ratio of required hemoglobin concentration, those with lower predialysis bicarbonate concentration had the characteristics of longer dialysis duration, higher ratio of twice weekly dialysis, larger BMI, higher concentra

关 键 词：维持性血液透析 代谢性酸中毒 碳酸氢盐浓度 

分 类 号：R318.16[医药卫生—生物医学工程]