中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (12): 660-663.doi: 10.3969/j.issn.1671-4091.2016.12.003

• 临床研究 • 上一篇    下一篇

平均实际血压变异对于维持性血液透析患者临床心血管预后的预测价值

吴昱1,李子芊2,孙芳3,刘婧3,马丽洁3,沈阳3,周亦伦1   

  1. 1. 天坛医院肾内科(吴昱和李子芊为本文共同第一作者)
    2. 北京大学第一医院 临床营养科
    3. 首都医科大学附属北京朝阳医院肾内科
  • 收稿日期:2016-07-29 修回日期:2016-09-30 出版日期:2016-12-12 发布日期:2016-12-05
  • 通讯作者: 周亦伦 zhouyilun2008@sina.cn E-mail:wywuyu@126.com

Prognostic value of average real variability of interdialytic blood pressure in maintenance hemodialysis patients

  • Received:2016-07-29 Revised:2016-09-30 Online:2016-12-12 Published:2016-12-05

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摘要： 目的本文拟评估血压变异度指标--平均实际变异(average real variability，ARV)对判断维持性血液透析(maintenance hemodialysis,MHD)患者临床心血管预后的预测价值。方法选择103 例MHD 患者，均于当周第2 次透析后，行44h 动态血压监测，计算出标准差(standard deviation，SD)、变异系数(coefficient of variation，CV)和ARV。随访2 年，收集患者预后资料，对相应的指标进行统计分析。结果Kaplan-Meier 分析表明，根据44h 收缩压(systolic blood pressure，SBP)标准差
(44h-SBPSD)和44h 收缩压变异系数(44h-SBPCV)均数进行分组，生存曲线分布无统计学意义(44h-SBPSD：Log Rank χ2=0.210，P=0.647;44h-SBPCV：Log Rank χ2=2.738，P=0.098)；而根据44h-SBP ARV 均数进行分组，高44h-SBP ARV 组生存率明显低于低44h-SBP ARV 组(77.8% 比98.0%，Log Rank χ2=9.645, P=0.002)。多因素Cox 回归分析结果提示，44h-SBP ARV(HR 1.132，95% CI 0.912～1.312，P=0.017)及hs-CRP(HR 1.179，95% CI 0.621～3.554, P=0.009)是MHD 患者发生心血管死亡的独立危险因素。结论MHD 患者透析间期44h 的ARV 对心血管死亡有较高的预测价值，优于SD和CV。

关键词: 维持性血液透析, 高血压, 平均实际血压变异, 心血管死亡

Abstract: Objective To evaluate the prognostic value of average real variability (ARV) of interdialytic blood pressure for cardiovascular mortality in patients on maintenance hemodialysis (MHD). Methods A total of 103 MHD patients were enrolled and 44-hour ambulatory blood pressure monitoring was carried out
after the second hemodialysis session in a week. Standard deviation (SD), coefficient of variation (CV), and ARV of the interdialytic ambulatory systolic blood pressure in the 44-hour period (44h-SBP) was calculated. Patients were followed up for two years and the relevant indexes were analyzed. Results Kaplan- Meier analysis demonstrated that the survival curves were not significantly different between groups divided by means of the averaged SD (P=0.647) or CV (P=0.098) of 44h-SBP. However, the survival rate was significantly lower in the group with higher ARV of 44h- SBP than in that with lower ARV of 44h- SBP (77.8% vs.98.0%, P=0.002). Multivariate Cox regression demonstrated that ARV of 44h-SBP (HR=1.132, P=0.017) and hs-CRP (HR=1.179, P=0.009) were the independent risk factors for cardiovascular death. Conclusions The ARV of 44h-SBP had a higher prognostic value for cardiovascular death, superior to the averaged SD or CV of 44h-SBP.

Key words: Maintenance hemodialysis, Hypertension, Average real variability (ARV), Cardiovascular death