维持性血液透析患者发生低血压的Logistic回归分析  

Logistic regression analysis of the occurrence of hypotension in patients on maintenance hemodialysis

作　　者：孙纷纷 李仕亮 SUN Fen-fen;LI Shi-liang(Department of Nephrology,Pingxiang People's Hospital,Pingxiang 337000,China)

机构地区：[1]萍乡市人民医院肾内科,337000 [2]萍乡矿业集团责任有限公司总医院普外科,337000

出　　处：《中国实用医药》2025年第4期41-44,共4页China Practical Medicine

摘　　要：目的分析维持性血液透析(HD)患者发生低血压的独立危险因素,对提早预防维持性血液透析中低血压(IDH)发生提供科学的理论依据。方法选择行规律维持性血液透析≥6个月、年龄≥18岁的终末期肾病患者40例进行回顾性分析,根据有无发生IDH以1∶1配对分为低血压组和无低血压组,每组20例。收集患者一般临床资料,将P<0.05差异有统计学意义的指标纳入多因素Logistic回归分析,分析影响IDH发生的危险因素。结果低血压组年龄为(72.35±10.95)岁、透析龄为(44.8±30.0)个月、白蛋白为(34.33±4.00)g/L、N末端脑利钠肽前体(NT-proBNP)为(36015±21924)pg/ml、肌酐为(1033±291)μmoI/L、尿素为(29.46±8.38)mmol/L、血磷为(2.16±0.72)mmol/L、C反应蛋白(CRP)为(19.23±10.84)mg/L、甲状旁腺激素(PTH)为(663±450)pg/ml、超滤量为(2505±711)ml,无低血压组分别为(63.05±13.44)岁、(28.2±19.1)个月、(37.13±4.42)g/L、(21425±13314)pg/ml、(751±315)μmoI/L、(22.89±8.09)mmol/L、(1.75±0.54)mmol/L、(4.20±7.46)mg/L、(302±264)pg/ml、(2012±770)ml。低血压组与无低血压组年龄、透析龄、白蛋白、NT-proBNP、肌酐、尿素、血磷、CRP、PTH、超滤量比较,差异均有统计学意义(P<0.05);低血压组与无低血压组血红蛋白、血钙、糖尿病肾病、性别比较,差异均无统计学意义(P>0.05)。年龄大[OR=7.869,95%CI=(1.660,37.291)]、透析龄长[OR=2.119,95%CI=(1.124,3.993)]、PTH高[OR=1.513,95%CI=(1.049,2.182)]、超滤量大[OR=2.045,95%CI=(1.054,3.968)]是终末期肾病患者IDH的独立危险因素,其中年龄是终末期肾病患者IDH最重要的独立危险因素(χ^(2)=6.754,P=0.009<0.05)。结论年龄、透析龄、白蛋白、NT-proBNP、肌酐、尿素、血磷、CRP、PTH、超滤量是IDH发生的危险因素,其中尤以年龄、透析龄、PTH、超滤量与IDH的发生关系密切,存在以上高危因素者维持性血液透析时可能需提早进行低血压预防。Objective To analyze the independent risk factors of hypotension in patients on maintenance hemodialysis(HD)and to provide scientific theoretical basis for early prevention of intradialytic-hypotension(IDH).Methods 40 patients with end-stage renal disease who had been on regular maintenance hemodialysis for≥6 months and were≥18 years old were selected for retrospective analysis,and were allocated into hypotensive group and non-hypotensive group based on the presence or absence of IDH on a 1∶1 pairing,with 20 cases in each group.General clinical data of the patients were collected,and indicators with statistically significant differences of P<0.05 were included in multivariate Logistic regression analysis to analyze the risk factors affecting the occurrence of IDH.Results In the hypotensive group,age was(72.35±10.95)years,age on dialysis was(44.8±30.0)months,albumin was(34.33±4.00)g/L,N-terminal pro-brain natriuretic peptide(NT-proBNP)was(36015±21924)pg/ml,creatinine was(1033±291)μmoI/L,urea was(29.46±8.38)mmol/L,blood phosphorus was(2.16±0.72)mmol/L,C-reactive protein(CRP)was(19.23±10.84)mg/L,parathyroid hormone(PTH)was(663±450)pg/ml,and ultrafiltration volume was(2505±711)ml;in the non-hypotensive group,those were(63.05±13.44)years,(28.2±19.1)months,(37.13±4.42)g/L,(21425±13314)pg/ml,(751±315)μmoI/L,(22.89±8.09)mmol/L,(1.75±0.54)mmol/L,(4.20±7.46)mg/L,(302±264)pg/ml,and(2012±770)ml.Comparison of age,dialysis duration,albumin,NT-proBNP,creatinine,urea,blood phosphorus,CRP,PTH and ultrafiltration volume between the hypotensive group and non-hypotensive group,the difference was statistically significant(P<0.05).Comparison of hemoglobin,blood calcium,diabetic nephropathy,and gender between the hypotensive group and the non-hypotensive group showed no statistically significant differences(P>0.05).Old age[OR=7.869,95%CI=(1.660,37.291)],longer dialysis duration[OR=2.119,95%CI=(1.124,3.993)],higher PTH[OR=1.513,95%CI=(1.049,2.182)],and excessive ultrafiltration volume[OR=2.045,95%CI=(1.054,3.

关 键 词：维持性血液透析 终末期肾病 透析中低血压 

分 类 号：R47[医药卫生—护理学]