腹膜透析患者诊室血压的变异和残余肾功能的关系研究

doi:10.3969/j.issn.1671-4091.2021.12.007

摘要/Abstract

摘要： 【摘要】目的血压的变异和心脑血管事件密切相关，但腹膜透析患者的诊室血压变异与残余肾功能及预后的关系目前仍罕见报道。方法入组515例规律随访的腹膜透析患者，收集患者随访期间的临床指标及实验室检查结果。根据入组患者的平均动脉压变异值(最小值：3.85，最大值：48.80)的四分位数12.40(9.43, 16.40)将入组患者分为4组，分别为低变异组(3.85～9.43)、低平均变异组(9.43～12.40)、高平均变异组(12.40～16.40)和高变异组(16.40～48.80)，边界值纳入下一组。比较4组患者临床及实验室指标的差异。结果4组患者的血清白蛋白[高变异组(34.8±5.2)g/l，高平均变异组(36.8±5.3)g/l，低平均变异组(37.0±5.4)g/l，低变异组(37.6± 4.5) g/l；F=5.385, P＜0.001]、初始尿量[高变异组494.0(296.0, 794.5)ml，高平均变异组611.0(493.5, 784.0)ml，低平均变异组671.0 (407.0, 946.0)ml, 低变异组699.0(504.0, 1000.0)；H=16.222, P=0.001]、随访期间的平均尿量[高变异组487.6(333.4, 748.9)ml，高平均变异组559.2(430.8,754.4)ml，低平均变异组657.7(510.7, 844.4)ml，低变异组706.8(501.0,913.9)ml；H=25.209，P＜0.001]、腹膜Kt/V[高变异组1.32(0.98，1.69)，高平均变异组1.18 (0.92，1.59)，低平均变异组1.14(0.81，1.48),低变异组1.10(0.90, 1.50)；H=13.147，P=0.004]和残肾Kt/V[高变异组0.56(0.25，0.88)，高平均变异组0.69(0.30，1.16)，低平均变异组0.75(0.50，1.08),低
变异组0.90(0.40，1.30)；H=21.384，P＜0.001]比较差异有统计学意义。Spearman's 相关分析显示血压变异程度和平均尿量之间呈负相关(β=-0.230，P＜0.001)。结论腹膜透析患者的血白蛋白、残余尿量和诊室血压变异密切相关。血压变异小的腹膜透析患者具有更多的残余尿和更好的营养状况，这可能直接影响腹膜透析患者的长期预后。

关键词: 腹膜透析, 诊室血压, 残余肾功能, 残余尿量, 营养状况

Abstract: 【Abstract】Objective Blood pressure variation is closely related to cardiovascular and cerebrovascular events. Nevertheless, the relationship between the variation of blood pressure measured at clinic and the residual renal function and prognosis of the peritoneal dialysis (PD) patients was rarely studied. Methods A total of 515 PD patients were enrolled in this study. They were followed up regularly, and their clinical indicators and laboratory test results during the follow-up period were collected. According to the interquartile mean arterial pressure variation values (3.85, 9.43, 12.4, 16.4, and 48.8), the enrolled patients were divided into four groups: low variation group (3.85～9.43), low average variation group (9.43～12.4), high average variation group (12.4～16.4), and high variation group (16.4～48.8); patient with a boundary value was arranged into the next group. Clinical and laboratory data were compared among the four groups. Results There were significant differences among low variation group, low average variation group, high average variation group and high variation group in serum albumin (37.6±4.5g/l, 37.0±5.4g/l, 36.8± 5.3g/l and 34.8±5.2g/l respectively; F=5.385, P＜0.001), initial urine volume [699.0 (504.0, 1000.0)ml, 671.0 (407.0, 946.0)ml, 611.0 (493.5, 784.0)ml and 494.0 (296.0, 794.5)ml respectively; H=16.222, P=0.001], average urine volume in the followup period [706.8 (501.0, 913.9)ml, 657.7 (510.7, 844.4)ml, 559.2 (430.8, 754.4)ml and 487.6 (333.4, 748.9)ml respectively; H=25.209, P＜0.001], peritoneal Kt/V [1.10 (0.90, 1.50), 1.14 (0.81, 1.48), 1.18 (0.92, 1.59) and 1.32 (0.98, 1.69) respectively; H=13.147, P=0.004], and residual kidney Kt/V [0.90 (0.40, 1.30), 0.75 (0.50, 1.08), 0.69 (0.30, 1.16) and 0.56 (0.25, 0.88) respectively; H=21.384, P＜0.001]. Spearman's correlation analysis showed a negative correlation between blood pressure variation and average urine volume (β=-0.230, P＜0.001). Conclusion In PD patients, serum albumin and residual urine volume were closely related to the clinic blood pressure variation. PD patients with low blood pressure variation usually had higher residual urine volume and better nutritional status and will directly relate to their long-term prognosis.

Key words: Peritoneal dialysis, Clinic blood pressure, Residual renal function, Residual urine volume, Nutritional status

中图分类号:

R544

赖美霞, 张骥, 涂文婷. 腹膜透析患者诊室血压的变异和残余肾功能的关系研究[J]. 中国血液净化, 2021, 20(12): 819-822.

参考文献

[1]Cho Y, Johnson DW.Peritoneal dialysis-related peritonitis: towards improving evidence, practices, and outcomes. Am J Kidney Dis. 2014 Aug; 64(2):278-89.[J].Am J Kidney Dis, 2014, 64(2):278-289
[2]俞雨生.残余肾功能状态是选择腹膜透析的关键[J].肾脏病与透析肾移植杂志, 2011, 20(3):255-256
[3]Sarafidis PA, Li S, Chen SC, et al.Hypertension awareness, treatment, and control in chronic kidney disease. Am J Med. 2008 Apr; 121(4): 332-40.[J].Am J Med, 2008, 121(4):332-340
[4]Zhang L, Wang F, Wang L, et al.Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet. 2012 Mar 3; 379(9818):8 15-22.[J].Lancet, 2012, 379(9818):815-822
[5]王梦婷, 李璐, 褚睿, 等.腹膜透析和血液透析患者血压变异性及节律性比较及其与心血管疾病死亡的相关性[J].中华肾脏病杂志, 2020, 36(12):925-925
[6]Singhal MK, Bhaskaran S, Vidgen E, et al.Rate of decline of residual renal function in patients on continuous peritoneal dialysis and factors affecting it. Perit Dial Int. 2000 Jul-Aug; 20(4):429-38.[J].Perit Dial Int, 2000, 20(4):429-438
[7]Bargman JM, Thorpe KE, Churchill DN et al.Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol 2001; 12: 2158–2162.[J].J Am Soc Nephrol, 2001, 20(4):2158-2162
[8]李晓, 李丽芹, 张家慧.慢性肾脏病透析前认知干预对患者治疗依从性与疾病改善效果的影响[J].护理实践与研究, 2018, 15(22):50-51
[9]沈麒云, 吴冬春, 李黎梅, 等.透析前教育对提高腹膜透析患者生活质量的影响[J].中国中西医结合肾病杂志, 2008, 9(2):156-157
[10]边薇, 官继超, 谢锡绍, 等.临时血液透析对维持性腹膜透析患者生存预后的影响[J].浙江大学学报医学版, 2016, 45(2):195-200
[11]蒋红樱, 汪涛.腹膜透析患者水盐清除与高血压的关系[J].中国血液净化, 2005, 4(5):243-245
[12]刘玲玲, 黄燕林, 杨玉颖, 等.基于行为阶段转变理论对腹膜透析患者实施容量管理的效果[J].护理学杂志, 2019, 34(13):48-51
[13]罗怡欣, 黄燕林, 侯璐蒙, 等.康复护理模式在改善腹膜透析患者水盐摄入依从性中的应用[J].广东医学, 2017, 38(3):491-494
[14]、Neri L, Viglino G, Marinangeli G, et al.Peritoneal Dialysis Study Group of Italian Society of Nephrology. Incremental start to PD as experienced in Italy: results of censuses carried out from 2005 to 2014. J Nephrol. 2017 Aug; 30 (4) :593-599.[J].J Nephrol, 2017, 30(4):593-599
[15]、全大勇, 杨斌, 舒英, 等.递增式腹膜透析对初期腹膜透析患者血压的影响及机制初探[J].四川医学, 2014, (5):536-538, 539.[J].四川医学, 2014, 1(5):536-538
[16]赵郁虹, 徐凤艳, 李晗笑, 等.生物电阻抗分析法评估容量超负荷对腹膜透析患者营养状况的影响[J].广东医学, 2019, 40(7):957-961
[17]吕晶, 薛武军, 尹爱萍, 等.容量负荷对腹膜透析患者营养状况的影响研究[J].中国全科医学, 2013, 16(14):1655-1657