摘要
目的探讨血管外肺水(EVLW)对维持性腹膜透析患者躯体功能的影响,为改善该人群的躯体功能提供依据。方法该横断面研究纳入2016年2至11月汕头市中心医院腹膜透析中心病情稳定的维持性腹膜透析患者,收集其人口统计学资料及相关临床数据。以肺超声显示的B线数目评估EVLW量、6 min步行试验得到的6 min步行距离(6MWD)评估躯体功能。采用Spearman相关分析法分析B线数目与6MWD的相关性。按6MWD的中位数值将患者分为高6MWD组和低6MWD组。单因素分析比较两组患者相关指标的差异,并行多因素Logistic回归分析确定躯体功能的独立影响因素。结果共纳入103例患者。B线数目为4(0,17)条,B线>5(EVLW过多)的患者有50例(48.5%);6MWD为402.0(355.3,455.5)m。6MWD与B线数目呈负相关(r=-0.591,P<0.001)。与高6MWD组相比,低6MWD组患者的年龄[(56.7±10.2)岁vs.(47.5±12.7)岁,P<0.001]、糖尿病肾病比例(48.1%vs.17.6%,P=0.001)、B线数目[16(3,20)条vs.0(0,6)条,P<0.001]、血B型尿钠肽[274(147,1 374)ng/L vs.94(41,280)ng/L,P<0.001]较高,而男性比例(46.4%vs.66.7%,P=0.036)、血红蛋白[(93.6±22.4)g/L vs.(105.8±15.2)g/L,P=0.002]、血白蛋白[(30.5±5.5)g/L vs.(34.6±4.8)g/L,P<0.001]、左心室射血分数[63.5%(49.0%,70.0%)vs.68.0%(64.0%,71.0%),P=0.011]较低。多因素Logistic回归分析显示,年龄(OR=0.872,95%CI:0.808~0.941,P<0.001)、B线数目(OR=0.880,95%CI:0.818~0.948,P=0.001)、血红蛋白(OR=1.066,95%CI:1.024~1.110,P=0.002)及左心室射血分数(OR=1.082,95%CI:1.014~1.155,P=0.018)是6MWD的独立影响因素。结论 EVLW过多是腹膜透析患者躯体功能下降的相关因素。有待进一步探讨应用肺超声指导EVLW的控制对改善患者躯体功能的价值。
Objective To investigate the relationship between extravascular lung water(EVLW) and physical function in maintenance peritoneal dialysis(MPD) patients. Methods Stable MPD patients were enrolled in a single-center cross-sectional study from February 2016 to November 2016. EVLW was evaluated by B lines number in lung ultrasonography and physical function was assessed by 6-minute walk distance(6MWD) in 6-minute walk test. The association between B lines number and 6MWD was examined by Spearman correlation analysis. Patients were divided into two groups according to the median of 6MWD. Demographic data and clinical parameters were compared between the two groups, and then multivariate binary Logistic regression analysis was applied to determine the independent risk factors for physical function. Results A total of 103 patients were included. Median B lines number was 4(0, 17). Fifty cases(48.5%) presented more than 5 B lines(defined as 'excessive EVLW'). 6MWD was 402.0(355.3, 455.5) meters, and it was inversely correlated with B lines number(r=-0.591, P<0.001). Compared to patients with longer 6MWD, average age [(56.7±10.2) years vs.(47.5±12.7) years, P<0.001], proportion of diabetic kidney disease(48.1% vs. 17.6%, P=0.001), B lines number [16(3, 20) vs. 0(0, 6), P<0.001] and serum B-type natriuretic peptide [274(147, 1 374) ng/L vs. 94(41, 280) ng/L, P<0.001] were higher, while proportion of male sex(46.4% vs. 66.7%, P=0.036), hemoglobin [(93.6±22.4) g/L vs.(105.8±15.2) g/L, P=0.002], serum albumin [(30.5±5.5) g/L vs.(34.6±4.8) g/L, P<0.001] as well as left ventricular ejection fraction(LVEF) [63.5%(49.0%, 70.0%) vs. 68.0%(64.0%, 71.0%), P=0.011] were lower in patients with shorter 6MWD. Multivariate analysis showed that age(OR=0.872, 95% CI: 0.808-0.941, P<0.001), B lines number(OR=0.880, 95% CI: 0.818-0.948, P=0.001), hemoglobin(OR=1.066, 95% CI: 1.024-1.110, P=0.002) and LVEF(OR=1.082, 95% CI: 1.014-1.155, P=0.018) remained independent correlates of 6MWD. Conclusions Excessive EVLW associates with the decl
出处
《中华临床医师杂志（电子版）》
CAS
2017年第7期1114-1120,共7页
Chinese Journal of Clinicians(Electronic Edition)
基金
广东省医学科研基金项目(B2016115)
关键词
尿毒症
腹膜透析
超声检查
血管外肺水
躯体功能
6min步行试验
Uremia
Peritoneal dialysis
Ultrasonography
Extravascular lung water
Physical function
6-minute walk test
