维持性血液透析患者透析期血压波动与透析相关并发症的相关性分析  

Analysis of the correlation between blood pressure fluctuation and hemodialysis-related complications in patients with maintenance hemodialysis

作　　者：朱旻霞[1,2] 张伟明[1,2] 倪兆慧[2] 蔡宏[1,2] 鲁嘉越[1,2] 刘上[1,2] 占雅萍[1,2] ZHU Min-xia;ZHANG Wei-ming;NI Zhao-hui;CAI Hong;LU Jia-yue;LIU Shang;ZHAN Ya-ping(Department of Nephrology,Renji Hospital South Campus,Shanghai Jiao Tong University School of Medicine,Shanghai 201112,China;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南院肾脏科,上海201112 [2]上海交通大学医学院附属仁济医院肾脏科,上海200127

出　　处：《上海交通大学学报（医学版）》2020年第4期484-488,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市卫生与计划生育委员会面上项目(201640100);上海市卫生与计划生育委员会青年项目(20164Y0231);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);上海交通大学医学院附属仁济医院南院培育基金(2017PYQA01)。

摘　　要：目的·探讨维持性血液透析(maintenance hemodialysis,MHD)患者透析期血压波动与慢性肾脏病-矿物质和骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)的相关性。方法·收集2009年1月—2015年4月上海交通大学医学院附属仁济医院血液透析中心433例MHD患者的临床资料、透析期治疗参数、实验室检测结果及用药情况。根据患者透析期收缩压(systolic blood pressure,SBP)差值,将患者分为血压高波动组(|△SBP|≥10 mmHg,234例)和血压低波动组(|△SBP|<10 mmHg,199例)。分析2组患者的血压波动情况及其与透析充分性、骨代谢指标及营养指标之间的关系。结果·与血压低波动组比较,血压高波动组患者中服用β受体阻滞剂及维生素D(vitamin D,VitD)的比例更高,血磷水平及全段甲状旁腺素(intact parathyroid hormone,iPTH)水平均较高,透析龄有所增加,尿素清除指数(Kt/V)、超滤量、体质量指数及血清白蛋白(serum albumin,ALB)均较低(均P<0.05)。不同血磷、iPTH患者的血压波动间差异具有统计学意义(均P<0.05),而不同血钙患者的血压波动间差异则无统计学意义。多因素Logistic回归分析显示透析龄、血磷和iPTH水平是MHD患者血压波动的独立危险因素,而Kt/V和ALB则是其保护性因素。结论·MHD患者透析期间的血压波动与CKD-MBD、营养状态、透析龄、透析充分性显著相关。Objective·To explore the correlation between blood pressure fluctuation and chronic kidney disease-mineral and bone disorder(CKD-MBD)in patients with maintenance hemodialysis(MHD).Methods·From Jan.2009 to Apr.2015,433 MHD patients in Hemodialysis Center of Renji Hospital,Shanghai Jiao Tong University School of Medicine were included,and their clinical data,treatment parameters during dialysis,lab examination indexes and drug applications were collected.According to the difference value of systolic blood pressure(SBP)during dialysis period,all the patients were divided into high fluctuation group of blood pressure(|△SBP|≥10 mmHg,n=234)and low fluctuation group of blood pressure(|△SBP|<10 mmHg,n=199).The blood pressure fluctuation and its relationship with dialysis adequacy,bone metabolism indicator and nutrition indicator were analyzed between the two groups.Results·Compared with the low fluctuation group of blood pressure,the patients in the high fluctuation group of blood pressure took higher proportion of β receptor blockers and Vit D,higher level of serum P and intact parathyroid hormone(iPTH),higher dialysis age,and lower Kt/V,ultrafiltration volume,body mass index(BMI)and serum albumin(ALB)level(all P<0.05).The blood pressure fluctuation between the patients with different serum P and iPTH levels was statistically significant(all P<0.05).There was no statistically significant difference in blood pressure fluctuation between the patients with different serum Ca levels.Multivariate Logistic regression analysis showed that dialysis age,serum P and iPTH levels were independent risk factors for blood pressure fluctuation of MHD patients,while Kt/V and ALB were protective factors.Conclusion·Blood pressure fluctuation in MHD patients during dialysis period is significantly correlated with CKD-MBD,nutritional status,dialysis age and dialysis adequacy.

关 键 词：维持性血液透析 血压波动 慢性肾病-矿物质和骨异常 

分 类 号：R459.5[医药卫生—治疗学]