预测人体水负荷回归公式个体化滴定血液透析患者目标体质量的临床应用  

Clinical application of overhydration regression formula to predict volume load for the individualized titration of dry weight in hemodialysis patients

作　　者：柴媛敏 孙秀丽[2] 李静[3] 陈爱珍[2] 侯国存[2] CHAI Yuan-min;SUN Xiu-li;LI Jing;CHEN Ai-zhen;HOU Guo-cun(Baotou Clinical Medical College,Inner Mongolia Medical University,Baotou 014040,China;Blood Purification Center,Baotou Central Hospital,Baotou 014040,China;Department of Neurology,Baotou Central Hospital,Baotou 014040,China)

机构地区：[1]内蒙古医科大学包头临床医学院,包头014040 [2]包头市中心医院血液净化中心,包头014040 [3]包头市中心医院神经内科,包头014040

出　　处：《中国血液净化》2020年第5期310-313,共4页Chinese Journal of Blood Purification

基　　金：包头市科技计划项目(编号2018C2007-2-15)。

摘　　要：目的建立本地区健康人群水负荷(overhydration,OH)回归公式,据此公式滴定维持性血液透析(maintenance hemodialysis,MHD)患者目标体质量,观察24h动态血压(ambulatory blood pressure monitor,ABPM)变化及不良事件发生率。方法第一阶段为观察性研究:入选包头市中心医院314名健康体检者,应用身体成分分析仪测量OH等身体成分,通过多重线性回归分析得到计算OH回归公式。第二阶段为干预性研究:入选MHD患者存在高水负荷且24h ABPM均值≥130/80mmHg,应用OH回归公式进行滴定目标体质量。结果健康人群得到OH的回归公式为:OH=6.203-0.019×Y-0.083×G-0.006×F+0.098×L-1.437×P(F=189.896,R2=0.755,P<0.001),[Y:年龄;G:性别;F:脂肪含量(kg);L:肌肉含量(kg);P:相位角(°)]。入选8名MHD患者每周调节干体质量0.5~1.0kg,调节后75%患者达到目标体质量。调节后24h ABPM监测收缩压≥180mmHg数据比例较调节前显著下降(t=4.831,P=0.002),收缩压≤159mmHg(1mmHg=0.133kPa)的比例较调节前上升(t=-6.207,P=0.001)。结论由健康人群所得OH计算公式支持个体化管理MHD患者体质量。Objective We first established a formula for calculating overhydration(OH)in healthy population in the local region,and then used this formula to titrate the target dry body weight and to observe the 24-hour ambulatory blood pressure monitoring(ABPM)changes and the incidence of adverse events in maintenance hemodialysis(MHD)patients.Methods The first stage of the study was an observational study,which enrolled 314 healthy people after physical examinations at Baotou Central Hospital.Body composition monitor(BCM)was used to measure their volume load status and body composition.The OH-related multiple regression formula was obtained by multivariate linear regression analysis.The second stage was an intervention study,which enrolled MHD patients with OH and mean 24-hour ABPM≥130/80 mmHg.The OH-related regression formula was applied to titrate the target dry weight.Results The multivariate linear regression formula for OH in healthy people is OH=6.203-0.019×Y-0.083×G-0.006×F+0.098×L-1.437×P(F=189.896,R2=0.755,P<0.001;Y:age;G:sex;F:lipid ass;L:lean tissue mass;P:phase angle).Eight MHD patients were enrolled in the study.After adjustment,75%of the patients had a dry weight compliant with the target value.The 24-hour ABPM showed that the proportion of systolic blood pressure≥180mmHg decreased from 30.188±15.957%to 4.088±2.719%(t=4.831,P=0.002),and the proportion of systolic blood pressure≤159mmHg increased from 28.713±24.672%to 71.688±16.545%(t=-6.207,P=0.001).Conclusion The OHrelated calculation formula obtained from healthy population can be used for dry body weight management individually in MHD patients.

关 键 词：目标体质量 水负荷 身体成分 24H动态血压监测 

分 类 号：R459.5[医药卫生—治疗学]