影响维持性血液透析患者容量负荷的相关因素分析  

The analysis of factors relating to volume load in maintenance hemodialysis patients

作　　者：李广义 侯毅[2] 吴敏[1] 王晓晶[2] 肖景香[2] 侯国存[3] 崔成立[1] LI Guangyi;HOU Yi;WU Min;WANG Xiaojing;XIAO Jingxiang;HOU Guocun;CUI Chengli(Baotou Medical College,Baotou 014040,China;Department of Ultrasound,Baotou Central Hospital;Department of Blood Purification Center,Baotou Central Hospital)

机构地区：[1]内蒙古科技大学包头医学院,内蒙古包头014060 [2]包头市中心医院超声科 [3]包头市中心医院血液净化中心

出　　处：《包头医学院学报》2020年第5期1-4,共4页Journal of Baotou Medical College

摘　　要：目的:探讨维持性血液透析(maintenance hemodialysis,MHD)患者容量负荷的影响因素。方法:纳入2018年10月至2019年4月在包头市中心医院MHD患者,利用生物电阻抗分析测得水负荷(overhydration,OH)和细胞外液(extracellular water,ECW),根据OH/ECW比值分为容量超负荷组(OH/ECW>15%)和容量正常组(OH/ECW≤15%),并记录超声心动图指标,应用多元线性回归分析OH/ECW比值的独立影响因素。结果:共有92例MHD患者入选本研究,其中容量超负荷24例(26%),糖尿病肾病在容量超负荷组比例更高(χ^2=4.946,P=0.026);与容量正常组相比,相位角(t=-4.216,P<0.001)、脂肪组织指数(t=-3.342,P=0.001)在容量超负荷组中降低,左房容积指数(Z=-2.436,P=0.015)在容量超负荷组中增大。相关分析显示:糖尿病肾病(r=0.330,P=0.001)、左房容积指数(r=0.303,P=0.003)、右房内径(r=0.295,P=0.004)与OH/ECW比值呈正相关,而相位角(r=-0.505,P<0.001)、脂肪组织指数(r=-0.339,P=0.001)、血红蛋白(r=-0.339,P=0.001)、肌酐(r=-0.322,P=0.002)、血钙(r=-0.224,P=0.032)与OH/ECW比值呈负相关。多元线性逐步回归显示糖尿病肾病(β=0.024,P=0.036)、低相位角(β=-0.035,P<0.001)、低脂肪组织指数(β=-0.006,P=<0.001)、左房容积指数增大(β=0.002,P=0.004)是OH/ECW比值升高的独立影响因素。结论:MHD患者常存在容量超负荷状态,尤其是糖尿病肾病,合并营养不良和左房容积指数增大的患者。Objective:To explore the factors relating to volume load status in maintenance hemodialysis(MHD)patients.Methods:The MHD patients treated in Baotou Central Hospital from October 2018 to April 2019 were enrolled in this study.The extracellular water(ECW)and overhydration(OH)were measured by a bioelectrical impedance analyzer,and according to the OH/ECW ratio,they were divided into volume overloaded group(OH/ECW>15%)and normal volume group(OH/ECW≤15%).The echocardiogram results between the two groups were analyzed.Multivariate linear regression was used to analyze the independent factors associated with OH/ECW value.Results:A total of 92 patients were enrolled in this study,24(26%)of the patients were of volume overload status.Diabetic nephropathy(DN)(χ^2=4.946,P=0.026)had a higher proportion in volume overloaded group;compared to normal volume group,the phase angle(PhA)(t=-4.216,P<0.001)and fat tissue index(FTI)(t=-3.342,P=0.001)decreased in volume overloaded group,and left atrial volume index(LAVI)(Z=-2.436,P=0.015)increased in volume overloaded group.Correlation study showed that DN(r=0.330,P=0.001),LAVI(r=0.303,P=0.003)and RAD(r=0.295,P=0.004)were positively associated with OH/ECW value.PhA(r=-0.505,P<0.001),FTI(r=-0.339,P=0.001),hemoglobin(Hb)(r=-0.339,P=0.001),serum creatinine(Scr)(r=-0.322,P=0.002)and serum calcium(Ca)(r=-0.224,P=0.032)were negatively associated with OH/ECW value.Multivariate linear regression analyses showed that DN(β=0.033,P=0.006),lower PhA(β=-0.037,P<0.001),lower FTI(β=-0.006,P=<0.001)and increased LAVI(β=0.030,P=0.002)were the independent factors relating to the increase of OH/ECW ratio.Conclusion:MHD patients often are present with capacity overload,especially with diabetic nephropathy,combined with malnutrition and increased left atrial volume index.

关 键 词：维持性血液透析 超声心动图 生物电阻抗分析 容量负荷 

分 类 号：R459.5[医药卫生—治疗学]