血液透析患者低钠透析后血管内皮舒张功能异常因素分析  

Analysis of the factors for vascular endothelial dysfunction after low sodium dialysis in maintenance hemodialysis

作　　者：沈剑 谢益女 叶灵 黄理[1] 王唯英[1] 庞军[1] SHEN Jian;XIE Yi-nv;YE Ling;HUANG Li;WANG Wei-ying;PANG Jun(Department of Nephrology,Yuyao People's Hospital of Zhejiang Province,Yuyao 315400,China)

机构地区：[1]余姚市人民医院肾内科(血液净化中心),浙江315400

出　　处：《中国血液净化》2023年第12期891-895,共5页Chinese Journal of Blood Purification

摘　　要：目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者低钠浓度透析后内皮舒张功能障碍(endothelial dysfunction,ED)的影响因素。方法 纳入2019年1月—2023年2月余姚市人民医院行MHD治疗的患者,设定透析液钠离子浓度为137 mmol/L,比较低钠透析6个月后肱动脉反应性舒张直径增长百分率;Logistic回归分析危险因素;建立列线图模型,自抽样法验证,受试者工作特征(ROC)曲线和校准曲线评价区分度与准确性。结果 共纳入80例患者,其中ED轻度异常42例,重度异常18例。多因素Logistic回归显示:透析龄(OR=1.429,95%CI:1.241~1.657,P<0.001)、肱动脉血流量(OR=1.611,95%CI:1.472~1.713,P<0.001)、超敏C反应蛋白(OR=1.376,95%CI:1.194~1.582,P<0.001)、丙二醛(OR=1.518,95%CI:1.407~1.684,P<0.001)是ED的独立危险因素,白蛋白(OR=0.472,95%CI:0.318~0.609,P<0.001)和超氧化物岐化酶(OR=0.658,95%CI:0.523~0.791,P<0.001)是ED的保护因素。列线图预测ED风险显示出较高的辨别力,ROC曲线下面积0.889(95%CI:0.841~0.937),灵敏度90.79%,特异度80.73%,校准曲线显示预测概率与实际概率拟合度较高。结论 MHD患者透析龄长、肱动脉血流量大、高水平超敏C反应蛋白和丙二醛、低水平白蛋白和超氧化物岐化酶是低钠透析后ED的危险因素,应基于列线图模型对以上危险因素及时监测、预警。Objective To investigate the factors affecting vascular endothelial dysfunction(VED)after hemodialysis with low sodium dialysate in chronic kidney disease(CKD)patients.Methods The CKD patients undergoing maintenance hemodialysis(MHD)in Yuyao People's Hospital from January 2019 to February 2023 were included in this study.The sodium concentration in dialysate was set at 137mmol/L.The percentage of increased reactive diastolic diameter in brachial artery was compared at baseline and after 6 months of dialysis with low sodium dialysate.Logistic regression was used to analyze the risk factors for VED.A nomograph model was built and validated with self-sampling method.The discrimination and accuracy of the model were evaluated by receiver operating characteristic(ROC)curves and calibration curves.Results A total of 80 CKD patients were enrolled,including 42 with mild VED and 18 with severe VED.Multifactorial logistic regression showed that dialysis age(OR=1.429,95%CI:1.241~1.657,P<0.001),brachial artery blood flow(OR=1.611,95%CI:1.472~1.713,P<0.001),hypersensitive C-reactive protein(OR=1.376,95%CI:1.194~1.582,P<0.001),and malonic dialdehyde(OR=1.376,95%CI:1.194~1.582,P<0.001)were the independent risk factors for VED;albumin(OR=0.472,95%CI:0.318~0.609,P<0.001)and superoxide dismutase(OR=0.658,95%CI:0.523~0.791,P<0.001)were the protective factors for VED.The nomograph showed a high discrimination ability in predicting the risk of VED.The area under the ROC curve was0.889(95%CI:0.841~0.937);the sensitivity was 90.79%and the specificity was 80.73%.The calibration curve showed a good fit between predicted and actual probabilities.Conclusion Longer dialysis age,higher brachial artery blood flow,higher serum hypersensitive C-reactive protein,higher serum malonic dialdehyde,low serum albumin,and lower serum superoxide dismutase are the risk factors for VED after hemodialysis with low sodium dialysate in CKD patients.The nomograph model can be used for close monitoring and early warning of these risk factors.

关 键 词：维持性血液透析 低钠透析 内皮功能障碍 

分 类 号：R459.5[医药卫生—治疗学]