中老年维持性血液透析患者透析过程中脑血流量变化  

Analysis of changes in cerebral blood flow during maintenance hemodialysis in middle-aged and elderly patients

作　　者：郭一丹 崔玮 叶鹏鹏 石志华 贾萌 周晓玲 罗洋 Guo Yidan;Cui Wei;Ye Pengpeng;Shi Zhihua;Jia Meng;Zhou Xiaoling;Luo Yang(Department of Nephrology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Neurology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;National Center for Chronic and Non-communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 100053,China)

机构地区：[1]首都医科大学附属北京世纪坛医院肾内科,北京100038 [2]首都医科大学附属北京世纪坛医院神经内科,北京100038 [3]中国疾病预防控制中心慢性和非传染性疾病预防控制中心,北京100053

出　　处：《中华肾脏病杂志》2024年第10期792-797,共6页Chinese Journal of Nephrology

基　　金：首都卫生发展科研专项项目(首发2022-2-2081);北京市科学技术委员会国家重大研发计划匹配项目(Z161100002616005)。

摘　　要：目的探讨中老年维持性血液透析(maintenance hemodialysis,MHD)患者透析过程中脑血流量的变化及其相关因素。方法该研究为前瞻性观察研究。研究对象来自2023年1月至2023年6月在首都医科大学附属北京世纪坛医院接受MHD治疗、年龄≥50岁的患者。收集入选者一般临床资料,同时记录和计算透析相关指标。采用经颅多普勒血流分析仪监测患者透析过程中不同时间点大脑中动脉平均流速(mean flow velocity,MFV),并作为评价脑血流量指标。分别于透析前15 min(T1)和透析15 min(T2)、30 min(T3)、60 min(T4)、120 min(T5)、180 min(T6)及透析结束时(T7)共7个时间点测定双侧颞窗大脑中动脉MFV值,取平均值。计算透析前与透析后大脑中动脉MFV的差值(ΔMFV)。采用Spearman相关法分析临床指标与ΔMFV的相关性,采用多因素线性回归法分析ΔMFV变化的相关因素。结果该研究共纳入MHD患者123例,年龄(63.63±8.44)岁(50~85岁),其中男性99例(80.5%)。与透析前相比,患者透析结束时MFV显著下降(Z=-7.650,P<0.001)。Spearman相关分析结果显示,超滤量(r=0.356)、超滤率(r=0.371)、收缩压差(透析前-透析结束,r=0.251)、平均动脉压差(透析前-透析结束,r=0.194)、合并糖尿病(r=0.293)、透析龄(r=0.220)、尿素清除指数(r=0.287)及血清白蛋白(r=-0.295)等因素与ΔMFV相关(均P<0.05)。多因素线性回归分析结果显示,合并糖尿病(B=3.889,95%CI 1.373~6.405,P=0.003)、血清白蛋白降低(B=-0.456,95%CI-0.877~-0.036,P=0.034)、超滤率增加(B=11.099,95%CI 6.402~15.797,P<0.001)和收缩压下降(B=0.062,95%CI 0.008~0.116,P=0.026)是透析过程中MFV下降的独立风险因素。结论中老年MHD患者透析过程中脑血流量呈下降趋势。合并糖尿病、血清白蛋白降低、超滤率增加及收缩压下降是透析过程中脑血流量下降的风险因素。Objective To investigate the changes and associated factors of cerebral blood flow in middle-aged and elderly patients undergoing maintenance hemodialysis(MHD).Methods This was a prospective observational study.End-stage renal disease(ESRD)patients undergoing MHD aged over 50 years at Beijing Shijitan Hospital,Capital Medical University from January 2023 to June 2023 were included.General clinical data of the selected individuals were collected,and dialysis related indicators were recorded and calculated.Mean flow velocity(MFV)of the middle cerebral arterial was measured by transcranial Doppler sonography(TCD)to represent cerebral blood flow throughout dialysis.Hemodialysis-related variables were collected.The MFV values of bilateral middle cerebral artery were measured through temporal windows at 7 time points:15 minutes before dialysis(T1),15 minutes(T2),30 minutes(T3),60 minutes(T4),120 minutes(T5),180 minutes(T6)during dialysis,and the endpoint of dialysis(T7),and the average values were recorded.TheΔMFV was calculated as pre-minus endpoint values of MFV.The Spearman rank correlation method was used to analyze the correlations betweenΔMFV and dialysis-related variables,and multiple linear regression method was used to analyze the related factors of the changes in MFV.Results This study included a total of 123 patients undergoing MHD,aged(63.63±8.44)years(range 50-85 years),including 99 males(80.5%).TCD examination demonstrated a decline trend in MFV throughout dialysis.The MFV at T7 was significantly lower than that at T1(Z=-7.650,P<0.001).The Spearman correlation analysis showed that the decline in MFV was correlated with ultrafiltration volume(r=0.356),ultrafiltration rate(r=0.371),the difference in systolic pressure(pre-analysis minus post-dialysis,r=0.251),the difference in mean arterial pressure(pre-dialysis minus post-dialysis,r=0.194),combined diabetes(r=0.293),dialysis vintage(r=0.220),Kt/V(r=0.287),and serum albumin(r=-0.295).Multiple linear regression analysis showed that combined with diabetes(B

关 键 词：肾透析 超声检查 多普勒 经颅 脑 脑血管循环 超滤 

分 类 号：R692.5[医药卫生—泌尿科学]