临床常用指标在腹膜透析患者容量状态评估中的价值  

Role of common clinical indicators in volume assessments of peritoneal dialysis patients

作　　者：苏新玙 刘苗 俞赞喆[1] 严豪[1] 李振元[1] 张贺[1] 袁江姿[1] 倪兆慧[1] 方炜[1] SU Xin-yu;LIU Miao;YU Zan-zhe;YAN Hao;LI Zhen-yuan;ZHANG He;YUAN Jiang-zi;NI Zhao-hui;FANG Wei(Shanghai Research Center for Peritoneal Dialysis,Department of Nephrology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科、上海市腹膜透析研究中心,上海200127

出　　处：《上海交通大学学报（医学版）》2018年第8期910-916,910,共7页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金(81370864,81670691);上海市教育委员会高峰高原学科建设计划(20152211)~~

摘　　要：目的·探讨临床常用指标在腹膜透析(简称腹透)患者容量评估中的应用价值。方法·选择2016年11月—2017年11月于上海交通大学医学院附属仁济医院规律腹透的患者,收集患者人口统计学资料,检测临床指标,应用多频生物电阻抗技术测量超负荷液体量(overhydration,OH),并分析其他临床指标与OH的关系。结果·共有200例患者入选该研究,其中男性117例(58.5%),平均年龄(56.3±13.8)岁,中位透析龄46.6个月,42例(21.0%)患者合并糖尿病。该组患者中容量超负荷(OH>1.1 L)患者共141例(70.5%)。与容量正常患者相比,容量超负荷患者的血压、浮肿程度和脑钠肽(brainnatriuretic peptide,BNP)均明显升高(均P<0.05)。容量超负荷患者中,51例(36.2%)血压正常,67例(47.5%)无浮肿,46例(32.6%)BNP<100 pg/mL。容量正常患者中,20例(33.9%)血压升高,8例(13.6%)有浮肿,1例(1.7%)BNP>400 pg/mL。收缩压、BNP与OH呈正相关(收缩压r=0.361,P=0.001;BNPr=0.615,P=0.000);浮肿程度越重的患者OH越高(P=0.000)。结论·血压、浮肿程度及BNP水平均与腹透患者容量状态密切相关,但单一临床指标并不能准确评估所有腹透患者容量状态,因此临床上应采用多种指标综合判断来评估腹透患者的容量状态。Objective·To investigate the role of common clinical indicators in volume assessments of peritoneal dialysis（PD） patients. Methods·Eligible PD patients in Renji Hospital, Shanghai Jiao Tong University School of Medicine from Nov. 2016 to Nov. 2017 were enrolled. Demographic data of patients were collected and clinical parameters were measured. Hydration status index overhydration（OH） was measured by bioimpedance spectroscopy, and the association between clinical indicators and OH was analyzed. Results·A total of 200 PD patients aged 56.3±13.8 years with median PD duration of 46.6 months were enrolled in the study. Among them, 117（58.5%） patients were males and 42（21.0%） patients were diabetic. 141（70.5%） patients in the present study were overhydrated（OH1.1 L）. Compared to those with normal hydration, the overhydrated patients had higher blood pressure, more obvious edema and higher brain natriuretic peptide（BNP） level（P0.05）. In the overhydrated patients, 51（36.2%） patients had normal blood pressure, 67（47.5%） patients had no edema and 46（32.6%） patients had BNP less than 100 pg/mL. In the normal hydrated patients, 20（33.9%） patients had high blood pressure, 8（13.6%） patients had edema and 1（1.7%） patient had BNP higher than 400 pg/mL. Systolic pressure and BNP level were both correlated with OH positively（systolic pressure r=0.361, P=0.001; BNP r=0.615, P=0.000）. The patients who had more obvious edema also had higher OH（P=0.000）. Conclusion·Blood pressure, edema and BNP are closely associated with the hydration status, but only one of these clinical indicators can not accurately reflect the hydration status in all PD patients. Combination of different indicators may be useful in evaluation of hydration status in PD patients.

关 键 词：腹膜透析 容量状态 生物电阻抗 血压 浮肿程度 脑钠肽 

分 类 号：R692.5[医药卫生—泌尿科学]