中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (09): 577-582.doi: 10.3969/j.issn.1671-4091.2018.09.001

• 临床研究 •    下一篇

维持性血液透析患者容量超负荷的相关因素分析

程灵红1,张红梅1,常立阳1,范汝艳1,陆晓艳1,刘丹1   

  1. 1. 浙江中医药大学附属广兴医院
  • 收稿日期:2018-05-07 修回日期:2018-06-25 出版日期:2018-09-12 发布日期:2018-08-24
  • 通讯作者: 张红梅 lh85281908@sina.com E-mail:lh85281908@sina.com

The analysis of factors relating to volume overload in maintenance hemodialysis patients

  • Received:2018-05-07 Revised:2018-06-25 Online:2018-09-12 Published:2018-08-24

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摘要： 【摘要】目的应用多频生物电阻抗法测得维持性血液透析(maintenance hemodialysis, MHD)患者透析前后容量状态，探讨透析前容量超负荷的影响因素。方法选取2017 年12 月～2018 年4 月杭州市中医院MHD 患者，收集患者的临床资料，透析前生化指标，应用多频生物电阻抗法测得患者容量超负荷指标即水负荷值(overhydration，OH)。采用多重线性回归分析OH 值的独立影响因素。结果共有196 例MHD 患者入选本研究，透析前容量正常(-1.1L≤OH≤1.1L)患者52 例(27%)，容量超负荷(OH＞1.1L)患者共144 例(73%)，其中89 例(45%)MHD 患者存在中度容量超负荷(1.1L＜OH≤2.5L)，55 例(28%)MHD 患者存在重度容量超负荷(OH＞2.5L)。透析后仍有29 例(15%)患者存在容量超负荷。相关分析显示：性别(r=-0.322,P＜0.001)、合并糖尿病(r=0.432,P＜0.001)、合并心血管疾病(r=0.346,P＜0.001)、合并高血压(r=0.166,P=0.020)、查尔森合并症指数(r=0.433,P＜0.001)、收缩压(r=0.266,P＜0.001)、血红蛋白(r=-0.210,P=0.003)、血清白蛋白(r=-0.211,P=0.003)、空腹血糖(r=0.397,P＜0.001)、尿素清除指数(r=-0.287,P＜0.001)、高敏C 反应蛋白(r=0.202,P=0.005)与OH 值相关。多重线性回归分析结果显示:男性(β= -0.580,P=0.001)、合并糖尿病(β=0.949，P＜0.001)、合并心血管疾病(β=0.632,P =0.001)、高收缩压(β=0.014,P＜0.001)、低血清白蛋白(β=-0.062,P=0.007)、低脂肪组织指数(β= -0.073,P=0.003)是透析前OH 值升高的独立影响因素。结论MHD 患者透析前普遍处于容量超负荷状态，容量超负荷患者达73%，重度容量超负荷达28%，值得医务工作人员重视。尤其需要关注男性、高收缩压、合并糖尿病、合并心血管疾病、低血清白蛋白、低脂肪组织指数患者，透析后大部分患者容量状态趋于正常，仍有15% MHD 患者存在容量超负荷。

关键词: 维持性血液透析, 容量超负荷, 生物电阻抗法

Abstract: 【Abstract】Objective To investigate volume overload status before and after dialysis, and to analyze the factors relating to overhydration before dialysis in maintenance hemodialysis (MHD) patients. Methods The MHD patients treated in Hangzhou Traditional Chinese Medical Hospital from December 2017 to April 2018 were enrolled in this study. Clinical data and biochemical results were recruited. The hydration status index, i.e. overhydration (OH) value, was measured by using bioimpedance spectroscopy. Multivariate linear regression was used to analyze the independent factors associated with overhydration. Results Atotal of 196MHD patients were enrolled in this study. Before dialysis, 52 (27%) of the patients were of normal volume (-1.1L ≤ OH ≤ 1.1L); 144 (73%) of the patients were overhydrated (OH ＞1.1L), in which 89 (45%) patients were moderate volume overloaded (1.1L＜OH≤2.5L), 55 (28%) patients were severe volume overloaded (OH＞2.5L). After dialysis, 29 patients (15%) were still volume overloaded. Correlation study showed that gender (r=-0.322, P＜0.001), diabetes (r=0.432, P＜0.001), cardiovascular disease (r=0.346, P＜0.001), hypertension (r=0.166, P=0.020), Chalson comorbidity index (r=0.433, P＜0.001), systolic pressure (r= 0.266, P＜0.001), hemoglobin (r=-0.210, P=0.003), serum albumin (r=-0.211, P=0.003), fasting blood glucose (r=0.397, P＜0.001), urea clearance index (r=-0.287, P＜0.001), and high sensitive C reactive protein (r=0.202, P=0.005) were associated with OH value. Multivariate linear regression analyses showed that male (β=-0.580, P=0.001), diabetes (β=0.949, P＜0.001), cardiovascular disease (β=0.632, P=0.001), higher systolic pressure (β=0.014, P＜0.001), lower serumalbumin (β=-0.062, P=0.007), and lower fat tissue index (β=-0.073, P=0.003) were the independent factors relating to the increase of OH before dialysis. Conclusion Overhydration is frequently seen inMHD patients before dialysis. In this cohort of MHD patients, 73% patients were overhydrated and 28% patients were severely volume overloaded before dialysis. Therefore more attention should be paid to the volume overload status inMHD patients, especially in males and those with hypertension, diabetes, cardiovascular disease, lower serum albumin and lower fat tissue index. After dialysis, the volume overload status improved significantly in most patients and remained in 15% MHD patients.

Key words: Maintenance hemodialysis patients, Volume overload, Bioimpedance spectroscopy