人体成分对血液透析充分性的影响  

Effect of body composition on dialysis quality（Kt/V）： a single center study

作　　者：侯国存 甘华[1] 孙秀丽[2] 李静[2] 陈爱珍[2] 温强[2] 刘爱英[2] 冯国徵[2] 闫海霞[2] 李慧霞[2] Hou Guocun;Gan Hua;Sun Xiuli;Li Jing;Chen Aizhen;Wen Qiang;Liu Aiying;Feng Guozhen;Yan Haixia;Li Huixia(Department of Nephrology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院肾内科,400016 [2]包头市中心医院肾内科血液透析中心

出　　处：《中华肾脏病杂志》2018年第6期418-423,共6页Chinese Journal of Nephrology

摘　　要：目的探索身体成分与血液透析充分性之间的关系。方法选取维持性血液透析（maintenance hemodialysis，MHD）患者，在同一次血液透析中应用2种方法评估透析充分性，并分析二者的相关性。（1）血液透析前后抽取患者全血检测尿素氮水平，根据Daugirdas公式计算Kt／Vdau；（2）应用人体成分分析仪（body composition monitor，BCM）计算Kt／Vbcm[V值等同于BCM测量人体总水含量（total body water，TBW），Kt值由在线清除率监测（online clearance monitoring，OCM）计算得出]。由Bland—Altman分析得出Kt／Vbcm。与Kt／Vdau的平均差值为0．07，以Kt／Vcbm值1．27为界，分为透析充分组和透析不充分组，比较两组患者身体成分各项指标差异，并应用逐步回归法分析Kt／Vbcm与人体成分指标之间的关系，对有意义指标进一步行受试者工作特征（ROC）曲线分析。结果本研究共纳入138例MHD患者，其中男性76例，占55．1％，年龄（54．9±12．7）岁。箱图显示Kt／Vdau存在较多“温和异常值”和“极端异常值”，Kt／Vdau与Kt／Vbcm值分别为1．432（1．235，1．718）和1．434（1．244，1．642），经配对秩和检验，差异无统计学意义（P=0．823）。Bland—Altman分析显示Kt／Vdau与Kt／Vbcm平均差值为0．07，95％置信区间为-0．66-0．79，相关系数为0．842（0．821～O．862）。Kt／Vbcm≥1．27组患者为年龄较大、体重指数（BMI）较小、身高较低、体重较轻、低肌肉组织指数（lean tissue index，LTI）、低TBW和低细胞内外液量。应用逐步回归分析表明Kt／Vbcm与TBw和LTI有线性回归关系（r=-0．834，P〈0．001；r=0．721，P〈0．001）。ROC曲线分析示TBW=30L为最佳临界值，其预测Kt／Vbcm不达标的敏感度为87．1％，特异度为86．5％；LTI=11．05kg／m2为最佳临界值，其预测Kt／Vbcm不达标的敏感度为60．4％，特异度为94．6％。结论Kt／Vbcm与Kt／VdauObjective To investigate the relationship between body composition and adequacy of dialysis, and analyze the related risk factors for inadequate delivery of hemodialysis. Methods In a prospective clinical trial, two different methods determining dialysis dose were simultaneously applied： Kt/Vdau （conventional method with Daugirdas＇ formula） and Kt/Vbcm [online clearance monitoring （OCM） measurement with V measured by body composition monitor （BCM）]. Using the value of 1.27 as the boundary, the patients were divided into two groups： Kt/Vbcm 〈 1.27 group and Kt/Vbcm ≥ 1.27 group. Clinical indices were compared between the two groups. Multiple linear regression was applied to analyze the potential impact factors of the difference between Kt/V values calculated by the two methods. Receiver operator characteristic （ROC） curve was applied to analyze meaningful factors. Results A total of 138 maintenance hemodialysis patients with age of （54.9±12.7） years old were enrolled, and 55.1% of them were males. There was no significant difference between Kt/Vdau and Kt/Vbcm, [ 1.432（1.235, 1.718） vs 1.434 （1.244, 1.642）, P=0.823]. Kt/Vdau was incidentally prone to falsely high values due to operative errors, whereas in these eases OCM- based measurement Kt/Vbcm, delivered realistic values. An excellent correlation was observed between Kt/Vdau and Kt/Vbcm; the mean difference was 0.07, 95%CI （-0.66- 0.79）; the correlation coefficient was 0.842（0.821 - 0.862）. The patients in Kt/Vbcm≥ 1.27 group had older age, lower body mass index （BMI）, lower height and weight, lower total body water （TBW）, lower extracellular water, lower intraeellular water, and lower lean tissue index （LTI） compared to those in Kt/Vbom 〈 1.27 group. Excellent correlations were observed between Kt/Vbcm, and TBW or LTI （r=-0.834, P 〈 0.001; r=-0.721, P 〈 0.001）. ROC curve analysis showed that the sensitivity and specificity of predicting inadequate delivery of hemodialysis were 87.1% and 86

关 键 词：肾透析 身体成分 危险因素 透析充分性 人体总液量 肌肉组织 指数 

分 类 号：R692.5[医药卫生—泌尿科学]