腹膜透析患者诊室血压的变异和残余肾功能的关系研究  

Study on the relationship between variation of clinic blood pressure and residual renal function in patients with peritoneal dialysis

作　　者：赖美霞 张骥[1] 涂文婷 LAI Mei-xia;ZHANG Ji;TU Wen-ting(Department of Nephrology,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院肾内科,温州325000

出　　处：《中国血液净化》2021年第12期819-822,共4页Chinese Journal of Blood Purification

摘　　要：目的血压的变异和心脑血管事件密切相关,但腹膜透析患者的诊室血压变异与残余肾功能及预后的关系目前仍罕见报道。方法入组515例规律随访的腹膜透析患者,收集患者随访期间的临床指标及实验室检查结果。根据入组患者的平均动脉压变异值(最小值:3.85,最大值:48.80)的四分位数12.40(9.43,16.40)将入组患者分为4组,分别为低变异组(3.85~9.43)、低平均变异组(9.43~12.40)、高平均变异组(12.40~16.40)和高变异组(16.40~48.80),边界值纳入下一组。比较4组患者临床及实验室指标的差异。结果4组患者的血清白蛋白[高变异组(34.8±5.2)g/l,高平均变异组(36.8±5.3)g/l,低平均变异组(37.0±5.4)g/l,低变异组(37.6±4.5)g/l;F=5.385,P<0.001]、初始尿量[高变异组494.0(296.0,794.5)ml,高平均变异组611.0(493.5,784.0)ml,低平均变异组671.0(407.0,946.0)ml,低变异组699.0(504.0,1000.0);H=16.222,P=0.001]、随访期间的平均尿量[高变异组487.6(333.4,748.9)ml,高平均变异组559.2(430.8,754.4)ml,低平均变异组657.7(510.7,844.4)ml,低变异组706.8(501.0,913.9)ml;H=25.209,P<0.001]、腹膜Kt/V[高变异组1.32(0.98,1.69),高平均变异组1.18(0.92,1.59),低平均变异组1.14(0.81,1.48),低变异组1.10(0.90,1.50);H=13.147,P=0.004]和残肾Kt/V[高变异组0.56(0.25,0.88),高平均变异组0.69(0.30,1.16),低平均变异组0.75(0.50,1.08),低变异组0.90(0.40,1.30);H=21.384,P<0.001]比较差异有统计学意义。Spearman's相关分析显示血压变异程度和平均尿量之间呈负相关(β=-0.230,P<0.001)。结论腹膜透析患者的血白蛋白、残余尿量和诊室血压变异密切相关。血压变异小的腹膜透析患者具有更多的残余尿和更好的营养状况,这可能直接影响腹膜透析患者的长期预后。Objective Blood pressure variation is closely related to cardiovascular and cerebrovascular events.Nevertheless,the relationship between the variation of blood pressure measured at clinic and the residual renal function and prognosis of the peritoneal dialysis(PD)patients was rarely studied.Methods A total of 515 PD patients were enrolled in this study.They were followed up regularly,and their clinical indicators and laboratory test results during the follow-up period were collected.According to the interquartile mean arterial pressure variation values(3.85,9.43,12.4,16.4,and 48.8),the enrolled patients were divided into four groups:low variation group(3.85~9.43),low average variation group(9.43~12.4),high average variation group(12.4~16.4),and high variation group(16.4~48.8);patient with a boundary value was arranged into the next group.Clinical and laboratory data were compared among the four groups.Results There were significant differences among low variation group,low average variation group,high average variation group and high variation group in serum albumin(37.6±4.5g/l,37.0±5.4g/l,36.8±5.3g/l and 34.8±5.2g/l respectively;F=5.385,P<0.001),initial urine volume[699.0(504.0,1000.0)ml,671.0(407.0,946.0)ml,611.0(493.5,784.0)ml and 494.0(296.0,794.5)ml respectively;H=16.222,P=0.001],average urine volume in the followup period[706.8(501.0,913.9)ml,657.7(510.7,844.4)ml,559.2(430.8,754.4)ml and 487.6(333.4,748.9)ml respectively;H=25.209,P<0.001],peritoneal Kt/V[1.10(0.90,1.50),1.14(0.81,1.48),1.18(0.92,1.59)and 1.32(0.98,1.69)respectively;H=13.147,P=0.004],and residual kidney Kt/V[0.90(0.40,1.30),0.75(0.50,1.08),0.69(0.30,1.16)and 0.56(0.25,0.88)respectively;H=21.384,P<0.001].Spearman's correlation analysis showed a negative correlation between blood pressure variation and average urine volume(β=-0.230,P<0.001). Conclusion In PD patients, serum albumin and residual urine volume were closely related to the clinicblood pressure variation. PD patients with low blood pressure variation usually had higher residual

关 键 词：腹膜透析 诊室血压 残余肾功能 残余尿量 营养状况 

分 类 号：R544[医药卫生—心血管疾病]