透析前长期血压变异性对血液透析患者死亡率和心血管事件的影响  

Effect of long - term blood pressure variability before dialysis on mortality and cardiovascular events in hemodialysis patients

作　　者：薛渊[1] XUE Yuan(Department of Nephrology,Puyang People’s Hospital,Puyang,Henan 457000,China)

机构地区：[1]濮阳市人民医院肾内科,河南濮阳457000

出　　处：《医药论坛杂志》2023年第8期48-51,57,共5页Journal of Medical Forum

摘　　要：目的 探讨透析前长期血压变异性(BPV)对血液透析患者全因死亡率和主要不良心血管事件(MACE)的影响。方法 选取濮阳市人民医院2020年1月至2021年1月诊治的血液透析患者173例。在1年的时间间隔内评估患者透析前BPV。随访2年,分析透析前长期BPV与全因死亡率和MACE的相关性。结果 不同BPV水平患者年龄、合并症、终末期肾病(ESRD)病因、透析时间、白蛋白和降压药物使用差异有统计学意义。共22例患者死亡,全因死亡率12.72%,29例患者出现MACE,MACE发生率16.76%。全因死亡率和MACE风险升高与较高的透析前VIMSBP和VIMDBP相关,VIMSBP每增加1个SD,全因死亡率风险增加10.1%(95%CI:6.4%~12.5%),MACE风险增加9.1%(95%CI,5.9%~12.5%);VIMDBP每增加1 SD,全因死亡率风险增加12.0%(95%CI:4.7%~19.8%),MACE风险增加9.1%(95%CI:2.9%~15.6%)。不同水平基线SBP患者的VIMSBP与预后依然存在相关性,表明VIMSBP和预后的相关性不依赖于基线SBP。KaplanMeier曲线显示,高BPV患者2年内生存率低于低BPV患者。结论 较高的透析前BPV与血液透析患者全因死亡率和MACE升高相关,降低血压变异性的策略可能对血液透析患者有益。Objective To explore the effect of long-term blood pressure variability(BPV)before dialysis on all-cause mortality and major adverse cardiovascular events(MACE)in hemodialysis patients.Methods 173 hemodialysis patients were selected from January 2020 to January 2021.BPV before dialysis was evaluated within a one-year interval.Follow-up for 2 years was conducted to analyze the relationship between long-term BPV before dialysis and all-cause mortality together with MACE.Results There were significant differences in age,complications,etiology of end-stage renal disease(ESRD),dialysis time,albumin and antihypertensive drug use among patients with different BPV levels.A total of 22 patients died,all-cause mortality was 12.72%.29 patients had MACE,and the incidence of MACE was 16.76%.Elevated risk of all-cause mortality and MACE was associated with higher pre-dialysis VIMSBP and VIMDBP.Each 1 SD increase in VIMSBP,the all-cause mortality risk increased by 10.1%(95%CI:6.4%~12.5%),and the MACE risk increased by 9.1%(95%CI:5.9%~12.5%);Each 1 SD increase in VIMDBP,the all-cause mortality risk increased by 12.0%(95%CI:4.7%~19.8%),and the MACE risk increased by 9.1%(95%CI:2.9%~15.6%).There is still correlation between VIMSBP and prognosis in patients with different levels of baseline SBP,indicating that the correlation between VIMSBP and prognosis independent of baseline SBP.Kaplan Meier curve showed that the 2-year survival rate of patients with high BPV was lower than those with low BPV.Conclusion Higher BPV before dialysis is associated with increased all-cause mortality and MACE in hemodialysis patients.Strategies to reduce blood pressure variability may be beneficial for hemodialysis patients.

关 键 词：全因死亡率 血液透析 主要不良心血管事件 血压变异性 

分 类 号：R544[医药卫生—心血管疾病]