摘要
目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者透析过程中血压变异性(blood pres-sure variability,BPV)对患者心血管及全因死亡的影响。方法选取2014年7月1日～2016年6月31日在东南大学附属中大医院血液净化中心维持性血液透析的患者265例,行回顾性分析,记录血液透析前、透析中每小时及透析后的血压值及心血管死亡事件、全因死亡事件,分析不同水平BPV与患者随访期间心血管及全因死亡的关系。结果透析前收缩压BPV最高组与其它三组相比,心血管及全因死亡率最高(P<0.05);单因素COX回归分析显示透析前收缩压BPV是心血管及全因死亡的独立危险因素(P=0.02);多因素COX回归模型显示透析前收缩压BPV是心血管死亡的独立危险因素(P<0.001)。透析前舒张压BPV、透析中及透析后收缩压、舒张压BPV与心血管死亡、全因死亡无显著相关性(P>0.05)。结论血压绝对值不是MHD患者心血管死亡及全因死亡独立危险因素,透析前收缩压BPV是MHD患者心血管死亡的独立危险因素,对MHD患者的预后具有预测价值。
Objective To investigate the association between blood pressure variablility(BPV)with outcomes in hemodialysis patients.Methods In this retrospective study,we enrolled 265 patients on hemodialysis from July 1,2014 to June 31,2016 in Southeast University affiliated Zhongda Hospital.Blood pressure(BP)measurements were obtained before,every one hour in and after dialysis session to determine each patient’s BPV.The primary end-point was cardiovascular and all-cause mortality.And the associations between BPV and study outcomes were analyzed.Results The average BPV of SBP and DBP pre-,in and post-hemodialysis was 0.115±0.070,0.128±0.114,0.120±0.046,0.127±0.084,0.099±0.084,0.105±0.029,respectively.A higher BPV of predialysis SBP was significantly associated with higher rates of cardiovascular and all-cause mortality(P<0.05).The result of a univariate Cox regression analysis showed that the BPV of predialysis SBP was an independent risk factor for cardiovascular and all-cause mortality.And a mutivariate Cox regression model further indicated that the BPV of predialysis SBP was an independent risk factor for cardiovascular mortality.Conclusion In this study,we found that greater variability in predialysis SBP is an independent risk factor for cardiovascular mortality in hemodialysis patients.These results suggest that BPV of predialysis SBP might have prognostic value in patients with hemodialysis.
作者
王越
李婷婷
高民
刘宏
WANG Yue;LI Tingting;GAO Ming;LIU Hong(Department of Nephrology,Zhongda Hospital,Southeast University,Nanjing 210009,China)
出处
《西部医学》
2019年第2期227-231,共5页
Medical Journal of West China
基金
江苏省自然科学基金面上项目(BK20161437)
关键词
维持性血液透析
血压变异性
心血管死亡
全因死亡
危险因素
Maintenance hemodialysis
Blood pressure variability
Cardiovascular mortality
All cause mortality
Prognosis risk factor
