中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (02): 104-107.doi: 10.3969/j.issn.1671-4091.2017.02.009

• 临床研究 • 上一篇    下一篇

维持性血液透析患者透析前碳酸氢盐浓度与临床特征的关系

鲁嘉越1,朱旻霞1,张伟明1,蔡宏1,朱铭力2,倪兆慧2   

  1. 1. 上海交通大学医学院附属仁济医院南院肾脏科
    2. 上海交通大学医学院附属仁济医院肾脏科
  • 收稿日期:2016-06-27 修回日期:2016-11-22 出版日期:2017-02-12 发布日期:2017-02-12
  • 基金资助:

    上海交通大学医学院附属仁济医院南院临床学科创新共建平台建设项目(2014MDT02)

The relationship between predialysis bicarbonate concentration and clinical characteristics in maintenance hemodialysis patients

  • Received:2016-06-27 Revised:2016-11-22 Online:2017-02-12 Published:2017-02-12

PDF

372

摘要： 目的探讨维持性血液透析患者透前碳酸氢盐浓度与临床特征之间的关系。方法选取上海市仁济南院维持性血液透析患者291 例，采集基本透析资料，并于透析间隔最长的透析日进行常规血液生化检查。根据透析前碳酸氢盐浓度平均值以四分位法将患者分为4 组，比较不同透析前碳酸氢盐浓度分层对上述临床指标的影响。并以透析前碳酸氢盐浓度为因变量，采用Pearson 相关性分析，探讨其与上述临床指标的关系。其中计量资料采取ANOVA 方差分析，计数资料采取卡方检验，以P＜0.05 为有统计学差异。结果不同透析前碳酸氢盐浓度分组在透析龄(F=3.527，P=0.015)、每周2 次透析比例(χ2=3.527，P=0.015)、体质量指数(body mass index，BMI)(F=5.000，P=0.002)、血清白蛋白(F=7.336，P＜0.001)、透析前血肌酐(F=4.932，P=0.002)、血钙(F=2.969，P=0.032)、血磷(F=13.468，P＜0.001)这些指标上存在差异。Pearson 相关性分析结果显示，血液透析患者透析前碳酸氢盐浓度与透析龄(r=-0.118，P=0.022)、体质量指数(body mass index，BMI)(r=-0.153，P=0.004)、血清白蛋白(r=-0.285，P＜0.001)、透前血肌酐(r=-0.213，P＜0.001)、血磷(r=-0.378，P＜0.001)、全段甲状旁腺激素(r=-0.129，P=0.014)呈负相关，与血钙(r=0.113，P=0.027)呈正相关。结论血液透析患者在溶质清除稳定及平均血红蛋白浓度达标且无差异的情况下，透析前碳酸氢盐浓度较低的患者具有透析龄长、每周2 次透析比例高、BMI 较大、血浆白蛋白和透前肌酐较高、以及低钙高磷的特点。

关键词: 维持性血液透析, 代谢性酸中毒, 碳酸氢盐浓度

Abstract: Objective To explore the relationship between predialysis bicarbonate concentration and clinical characteristics in maintenance hemodialysis (MHD) patients. Methods A total of 291 MHD patients treated in our dialysis center were enrolled in this study. Their dialysis data and routine blood tests were collected. Patients were assigned into 4 groups according to the average bicarbonate concentration before dialysis by a quartile method, and clinical characteristics were then compared among the 4 groups. Pearson's correlation analysis was used to explore the relationship between predialysis bicarbonate concentration and clinical indicators, using predialysis bicarbonate concentrations as the dependent variables. Analysis of variance (ANOVA) was used for the analyses of measurement data, and chi square test was used for the analyses of count data. P＜0.05 was considered to be statistically significant. Results There were differences among the 4 groups in duration of dialysis (F=3.527, P=0.015), ratio of twice weekly dialysis (χ2=3.527, P=0.015), body mass index (BMI) (F=5.000, P=0.002), serum albumin (F=7.336, P＜0.001), serum creatinine (F=4.932, P=0.002), serum calcium (F=2.969, P=0.032), and serum phosphorus (F=13.468, P＜0.001). Pearson's correlation analyses demonstrated that predialysis bicarbonate concentration was negatively correlated with duration of dialysis (r=-0.118, P=0.022), BMI (r=-0.153, P=0.004), serum albumin (r=-0.285, P＜0.001), serum creatinine (r=-0.213, P＜0.001), serum phosphorus (r=-0.378, P＜0.001), and iPTH (r=-0.129, P=0.014), and was positively correlated with serum calcium (r=0.113, P= 0.027) in these MHD patients. Conclusions In MHD patients with stable clearance of solution and similar ratio of required hemoglobin concentration, those with lower predialysis bicarbonate concentration had the characteristics of longer dialysis duration, higher ratio of twice weekly dialysis, larger BMI, higher concentration of serum albumin, creatinine and phosphorus, and lower serum calcium.

Key words: Maintenance hemodialysis, Metabolic acidosis, Bicarbonate concentration