使用生物电阻抗技术辅助确定腹膜透析患者目标体质量的随机对照研究  

Determination of target body weight of peritoneal dialysis patients by bioimpedance:a randomized controlled clinical study

作　　者：武蓓[1] 王梅[1] 赵慧萍[1] 左力[1] 乔婕[1] 芦丽霞[1] 邵琳[1] 门春翠 何玉婷 WU Bei;WANG Mei;ZHAO Hui-ping;ZUO Li;QIAO Jie;LU Li-xia;SHAO Lin;MEN Chun-cui;HE Yu-ting(Department of Nephrology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院肾内科,北京100044

出　　处：《中国血液净化》2020年第3期165-169,共5页Chinese Journal of Blood Purification

基　　金：2015年度北京大学人民医院研究与发展基金(课题编号:RDC2015-31)。

摘　　要：目的验证以生物电阻抗分析辅助确定腹膜透析患者目标体质量的临床有效性和安全性。方法75名腹膜透析患者随机分为传统方法评价组和机体成分测定(body composition monitor,BCM)评价组。BCM评价组用实测体质量-过多水(over hydration,OH)+2kg作为目标体质量,指导患者容量管理。6个月后,比较2组试验前后容量相关指标的变化差异。结果BCM测量的OH值与传统容量评价指标水肿程度积分(r=0.366,P=0.001)、日降压药剂量(defined daily doses,DDDs)(r=0.440,P<0.001)、收缩压(r=0.494,P<0.001)、舒张压(r=0.414,P<0.001)、左心室舒张末内径(r=0.591,P<0.001)、脑钠肽(natriuretic peptide,BNP)(r=0.615,P<0.001)呈正相关,与白蛋白(r=-0.354,P=0.002)呈负相关。经BCM指导设定目标体质量治疗6个月后,BCM组体质量[(60.4±10.6)比(59.6±10.2)kg,t=2.988,P=0.005]、收缩压[(136.5±23.9)比(126.9±20.3)mmHg,t=2.238,P=0.033]、中度以上水肿患者比例(46.9%比37.5%,χ2=15.469,P<0.001)均较试验前明显下降。对照组实验前后上述指标无明显变化。结论以BCM协助确定患者目标体质量的方法可有效用于腹膜透析患者的容量管理。Objective To verify the clinical effectiveness and safety of using bioimpedance to determine the target body weight of peritoneal dialysis(PD)patients.Methods A total of 75 PD patients were randomly divided into traditional method group and body composition monitor(BCM)group.BCM group used the formula:target body weight=measured body weight-over hydration(OH)+2 kg,to guide patient volume management.After 6 months,changes of blood pressure,edema degree and brain natriuretic peptide(BNP)were compared between the two groups.Results The OH value by BCM was positively correlated with edema degree(r=0.366,P=0.001),defined daily doses(DDDs)of blood pressure medications(r=0.440,P<0.001),systolic pressure(r=0.494,P<0.001),diastolic pressure(r=0.414,P<0.001),left ventricular end diastolic dimension(r=0.591,P<0.001)and BNP(r=0.615,P<0.001),and was negatively correlated with albumin(r=-0.354,P=0.002).In BCM group after 6 months,body weight(60.4±10.6 vs.59.6±10.2;t=2.988,P=0.005),systolic blood pressure(136.5±23.9 vs.126.9±20.3;t=2.238,P=0.033)and the patients with moderate or higher than moderate edema(46.9%vs.37.5%;χ2=15.469,P<0.001)decreased;these changes were not observed in control group.Conclusion BCM can be used to help determine target body weight of PD patients.

关 键 词：腹膜透析 生物电阻抗 容量管理 目标体质量 

分 类 号：R459.5[医药卫生—治疗学]