中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (07): 450-455.doi: 10.3969/j.issn.1671-4091.2018.07.005

• 临床研究 • 上一篇    下一篇

人体成份分析仪联合在线清除率监测评估血液透析剂量的临床应用价值

侯国存1,孙秀丽1,陈爱珍1,温强1,李静1,刘爱英1,李慧霞1,闫海霞1   

  1. 1. 包头市中心医院血液透析中心
  • 收稿日期:2018-02-01 修回日期:2018-03-25 出版日期:2018-07-12 发布日期:2018-07-12
  • 通讯作者: 侯国存 houguocun2007@163.com E-mail:houguocun2007@aliyun.com
  • 基金资助:

    内蒙古医科大学科技百万工程联合项目资助，编号：YKD2017KJBW(LH)069

Evaluation of hemodialysis adequacy using body composition monitor combined with online clearance monitoring

  • Received:2018-02-01 Revised:2018-03-25 Online:2018-07-12 Published:2018-07-12

PDF

659

摘要： 【摘要】目的通过单中心前瞻性自身对照研究探讨人体成份分析仪(body composition monitor，BCM)联合在线清除率监测(online clearance monitoring，OCM)评估血液透析充分性的准确性和实用性。方法选取维持性血液透析(maintance hemodialysis，MHD)患者138 例，在同一次血液透析中应用3 种评估透析充分性方法：①血液透析前后抽取患者全血检测尿素氮水平，根据Daugirdas 公式计算Kt/VDau；②应用OCM 计算Kt/VOcm(尿素分布容积V 值由Watson 公式计算得出)；③应用BCM 计算Kt/VBcm(尿素分布容积V 值由BCM 测量得出，Kt 值由OCM 计算得出)。另外，以Kt/VBcm-Kt/VOcm差值0.25(根据Bland-Altman分析平均差值得出)为界，分为Kt/VBcm-Kt/VOcm＜0.25 组和Kt/VBcm-Kt/VOcm≥0.25 组，比较2 组患者临床资料和身体成份各项指标差异。结果本研究共纳入138 例MHD 患者，男性76 例，占55.934%，平均年龄(54.934 ± 12.705) 岁。3 种方法评估透析剂量分别为Kt/VDau1.432(1.235,1.718)，Kt/VBcm1.434(1.244,1.642)，Kt/VOcm 1.177(1.076,1.355)，Kt/VDau 与Kt/VBcm比较无统计学意义(Z=-0.224，P=0.823)。箱图显示Kt/VDau存在较多“温和异常值”和“极端异常值”。Bland-Altman 分析显示Kt/VDau与Kt/VBcm平均差值为0.07，95%置信区间(0.020，0.204)，相关系数为0.842(0.821～0.862)。Kt/VOcm和Kt/VBcm值的差异与两种方法使用不同尿素分布容积V 值有关(t=25.400，P＜0.001)。高龄(t=-3.748，P＜0.001)、女性(c2=5.163，P=0.023)、低肌肉组织指数(t=11.345，P＜0.001)、低人体总液量(t=7.988，P＜0.001)、低细胞内外液量(t=5.878，P＜0.001；t=8.564，P＜0.001)和高脂肪组织指数(t=-4.242，P＜0.001)患者Kt/VBcm-Kt/VOcm差值越大。LTI 和LTIdtr与Kt/VBcm-Kt/VOcm差值相关性最强(g=-0.781，P＜0.001；g=-0.728，P＜0.001)。结论BCM 联合OCM 监测功能可稳定、全面、准确评估患者透析剂量和有利于优化透析处方，值得临床推广使用。

关键词: 人体成份分析仪, 在线清除率监测, 维持性血液透析, Kt/V

Abstract: 【Abstract】Objective To evaluate hemodialysis adequacy using body composition monitor (BCM) and online clearance monitoring (OCM). Methods A total of 138 patients were recruited in this prospective clinical trial. Three methods determining dialysis dose were simultaneously applied: Kt/VDau (conventional method with Daugirdas formula), Kt/VOcm (OCM with urea distribution volume V based on anthropometric estimate), and Kt/VBcm (urea distribution volume V by BCM, and Kt value by OCM). Using the difference value of 0.25 between Kt/VBcm and Kt/VOcm as the boundary, we divided the patients into two groups: Kt /VBcm-Kt/VOcm <0.25 group and Kt/VBcm-Kt/VOcm≥0.25 group. Clinical indices were compared between the two groups. Linear regression was applied to analyze the potential impact factors for the difference between Kt/V values calculated by the two methods. Results A total of 138 MHD patients with an average age of 54.934±12.705 years old were enrolled, and 55.934% of them were males. The dialysis dose was measured as Kt/VDau 1.432(1.235,1.718), Kt/VBcm 1.434(1.244, 1.642) and Kt/VOcm 1.177(1.076,1.355). There was no difference between Kt/VDau and Kt/VBcm (Z=- 0.224, P=0.823). Kt/VDau was incidentally prone to falsely high or low values due to operative errors, whereas OCM-based measurement Kt/VBcm and Kt/VOcm delivered realistic values. An excellent correlation was observed between Kt/VDau and Kt/VBcm, the mean difference was 0.07 [95% CI (0.020, 0.204), r=0.842 (0.821~0.862)]. The difference between Kt/VBcm and Kt/VOcm was due to the difference between anthropometric estimated Vwatson and measured VBCM (t=25.400, P<0.001). A higher mean Kt/VBcm-Kt/VOcm value was correlated to older age (t=-3.748, P<0.001), female (c2=5.163, P=0.023), lower lean tissue index (t=11.345, P<0.001), lower total body water (t=7.988, P<0.001), lower extracellular water (t=8.564, P<0.001), lower intracellular water (t=5.878, P<0.001), and higher fat tissue index (t=-4.242, P<0.001). Excellent correlations were observed between lean tissue index (LTI) or LTI difference to reference and the mean Kt/VBcm - Kt/VOcm value (g=-0.781, P<0.001; g=-0.728, P<0.001). Conclusion BCM can give more accurate parameter of urea distribution volume, thus modifying the result of Kt/V. It is very useful not only to monitor adequacy of dialysis but also to evaluate nutritional status.

Key words: Body Composition Monitor, Online Clearance Monitoring, Maintance hemodialysis, Kt/V