摘要
目的观察维持性血液透析(MHD)患者透析前收缩压变异性(SBPV)的相关因素及其对远期预后的影响。方法记录2011年3月至5月期间50例MHD患者每次透析前的血压,计算透析前平均收缩压及标准差,并以血压离散系数表示透析前SBPV。在此期间记录患者一般情况,并行生化指标检测、心脏彩超检查。记录患者生存状况,随访5年至2016年5月31日。结果透析前收缩压血压变异性为(8.5%±2.1%)。Pearson相关分析显示SBPV与年龄、体质量指数(BMI)、舒张期左房内径(LAD)呈正相关关系(P<0.05),与透析前血肌酐(SCr)、甲状旁腺素(PTH)、碳酸钙剂量、活性维生素D剂量、平均舒张压具有负相关关系(P<0.05)。另外单因素方差分析显示糖尿病组、冠心病组及应用α受体阻滞剂组患者血压变异性分别较对应组高,差异具有统计学意义(P<0.05)。以透析前SBPV作为因变量,将以上具有统计学意义的各因素作为自变量进行多元线性回归分析,年龄、糖尿病、冠心病、BMI、LAD、SCr在方程中具有统计学意义,方程R2=0.630;随访5年,12例患者死亡,病死率24.0%。Kaplan-meier生存分析显示透析前SBPV增高组病死率显著增加(P<0.01)。结论伴有冠心病、糖尿病、年龄增加、LAD增大、高BMI、α受体阻滞剂的应用以及低浓度SCr是SBPV增高的独立危险因素;透析前SBPV增加与MHD患者全因病死率增加有关。
Objective To study the clinical variables that may plausibly influence predialysis systolic blood pressure variability（SBPV）,and to investigate the correlations of predialysis SBPV with all-cause mortality in patients receiving prevalent maintenance hemodialysis（MHD）.Methods A total of 50 patients were enrolled in the study.All the blood pressure values before each dialysis were recorded between March and May in 2011.The mean systolic pressure（SBP）was calculated,and SBPV was estimated with the coefficient of variability.During the three months,clinical data and related biochemical parameters were collected,and echocardiography was carried out to detect cardiac structure and function.Death events were recorded during the next five years.Results The predialysis SBPV was 8.5% ±2.1%.SBPV showed a positive correlation with the age,body mass index（BMI）and left atrial diameter（LAD）（P〈0.05 for all）.Meantime,SBPV showed a negative correlation with the serum creatinine（SCr）,average DBP,parathyroid hormone（PTH）,doses of calcium carbonate and activated vitamin D（P〈0.05）.Patients with diabetes mellitus（DM）,coronary artery disease（CAD）or taking alfablocker had higher SBPV（P〈0.05）.SBPV was used as a variate for conducting the multiple linear regression analysis,after adjustment,the seven variables of age,DM,CAD,BMI,LAD,SCr and taking alfa-blocker maintained their associations with predialysis SBPV（P〈0.05）.The equation of R^2=0.630.During 5 years of follow-up,12 patients died（24.0%）.The Kaplan-meier survival analysis showed that the predialysis SBPV elevation was associated with the mortality rate（P〈0.01）.Conclusions Advanced age,the history of DM and/or CAD,lower SCr,higher BMI and LAD,and taking alpha-blocker were the independent risk factors of increased predialysis SBPV.The predialysis SBPV increase is associated with all-cause mortality in patients given prevalent MHD.
出处
《临床肾脏病杂志》
2018年第2期97-102,共6页
Journal Of Clinical Nephrology
基金
南京市医学科技发展项目(No.YKK11211)
关键词
血液透析
血压变异性
收缩压
Hemodialysis
Blood pressure variability
Systolic pressure
