中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (12): 891-895.doi: 10.3969/j.issn.1671-4091.2023.12.002

• 临床研究 • 上一篇    下一篇

血液透析患者低钠透析后血管内皮舒张功能异常因素分析

沈 剑  谢益女  叶 灵  黄 理  王唯英  庞 军   

  1. 315400 浙江，1余姚市人民医院肾内科(血液净化中心)
  • 收稿日期:2023-06-13 修回日期:2023-09-18 出版日期:2023-12-12 发布日期:2023-11-30
  • 通讯作者: 沈剑 E-mail:sjhh13130@126net.com.cn

Analysis of the factors for vascular endothelial dysfunction after low sodium dialysis in maintenance hemodialysis

SHEN Jian, XIE Yi-nv, YE Ling, HUANG Li, WANG Wei-ying, PANG Jun   

  1. Department of Nephrology, Yuyao People's Hospital of Zhejiang Province, Yuyao 315400, China
  • Received:2023-06-13 Revised:2023-09-18 Online:2023-12-12 Published:2023-11-30
  • Contact: 315400 浙江，1余姚市人民医院肾内科(血液净化中心) E-mail:sjhh13130@126net.com.cn

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摘要： 探讨维持性血液透析（MHD）患者低钠透析后血管内皮舒张功能异常的影响因素。 方法 选取2019年1月至2023年2月于我院透析的慢性肾脏病（CKD）患者80例作为研究对象，依据低钠透析6个月后肱动脉反应性舒张直径增长百分率分为正常组（n=20）、轻度异常组（n=42）、重度异常组（n=18）；比较组间人口学资料、原发病情况、血常规、生化等资料差；Logistic回归模型筛选危险因素；建立列线图预测模型，以训练集Bootstrap抽样法验证，通过ROC曲线下面积（AUC）和校准曲线评价该模型的区分度与准确性。 结果 与正常组相比，重度异常组和轻度异常组的透析龄、收缩压、舒张压、流量、TG、hsCRP、MDA较高，而ALB、SOD较低，组间差异有统计学意义（P<0.05）。单因素及多因素Logistic回归分析显示，透析龄、肱动脉血流量、hsCRP、MDA是血管内皮舒张功能异常的独立危险因素，而ALB和SOD是其保护因素（P<0.01）。列线图模型显示，随着流量≥581.32 mL/min、MDA≥4.51 μmol/L、SOD≤70.58 mg/L、ALB≤36.74 g/L、hsCRP≥16.04 mg/dL、透析龄≥4年，血管内皮舒张功能异常的风险上升。ROC曲线AUC为0.889（95%CI：0.841～0.937，P<0.001），校准曲线显示该模型拟合度较好。 结论 透析龄长、肱动脉血流量大、高水平hsCRP、高水平MDA、低水平ALB、低水平SOD均是低钠透析后血管内皮舒张功能异常的危险因素，应基于列线图模型对以上危险因素及时监测、预警，有助于改善低钠透析患者预后。

关键词: 维持性血液透析, 低钠透析, 内皮功能障碍

Abstract: Objective  To investigate the factors affecting vascular endothelial dysfunction (VED) after hemodialysis with low sodium dialysate in chronic kidney disease (CKD) patients.  Methods The CKD patients undergoing maintenance hemodialysis (MHD) in Yuyao People's Hospital from January 2019 to February 2023 were included in this study. The sodium concentration in dialysate was set at 137mmol/L. The percentage of increased reactive diastolic diameter in brachial artery was compared at baseline and after 6 months of dialysis with low sodium dialysate. Logistic regression was used to analyze the risk factors for VED. A nomograph model was built and validated with self-sampling method. The discrimination and accuracy of the model were evaluated by receiver operating characteristic (ROC) curves and calibration curves. Results A total of 80 CKD patients were enrolled, including 42 with mild VED and 18 with severe VED. Multifactorial logistic regression showed that dialysis age (OR=1.429, 95% CI: 1.241～1.657, P＜0.001), brachial artery blood flow (OR=1.611, 95% CI: 1.472～1.713, P＜0.001), hypersensitive C-reactive protein (OR=1.376, 95% CI: 1.194～1.582, P＜0.001), and malonic dialdehyde (OR=1.376, 95% CI: 1.194～1.582, P＜0.001) were the independent risk factors for VED; albumin (OR=0.472, 95% CI: 0.318～0.609, P＜0.001) and superoxide dismutase (OR=0.658, 95% CI: 0.523～0.791, P＜0.001) were the protective factors for VED. The nomograph showed a high discrimination ability in predicting the risk of VED. The area under the ROC curve was 0.889 (95% CI: 0.841～0.937); the sensitivity was 90.79% and the specificity was 80.73%. The calibration curve showed a good fit between predicted and actual probabilities.  Conclusion  Longer dialysis age, higher brachial artery blood flow, higher serum hypersensitive C-reactive protein, higher serum malonic dialdehyde, low serum albumin, and lower serum superoxide dismutase are the risk factors for VED after hemodialysis with low sodium dialysate in CKD patients. The nomograph model can be used for close monitoring and early warning of these risk factors.

Key words: Maintenance hemodialysis, Low sodium dialysis, Endothelial dysfunction

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