目的  从脂质代谢探讨血液透析中低血压(intradialytic hypotension,IDH)发生的危险因素，为防治透析中发生低血压提供新的依据。 方法  回顾性纳入2023年9月—2025年9月在茂名市人民医院血液净化中心维持性血液透析的患者，收集临床资料、实验室检查结果和心脏超声结果等。IDH定义为透析中收缩压下降≥20 mmHg或平均动脉压下降≥10 mmHg，并伴有需要护士干预的低血压症状(如困倦、嗜睡、头晕、肌肉痉挛)，每月发生≥1次。无IDH组：3个月内透析中低血压频率＜1/10；IDH：3个月内至少每个月发生1次低血压事件，透析中低血压频率≥1/10。采用Pearson或Spearman分析载脂蛋白A1(apolipoprotein A1,apoA1)和高密度脂蛋白胆固醇(high-density lipoprotein-cholesterol,  HDL-C)相关影响因素，采用二元Logistic回归分析IDH的危险因素。 结果 本研究共纳入216例患者，无IDH组120例，IDH组96例(44.4%)。IDH组HDL-C(t=5.203,P＜0.001)和apoA1(t=5.571,P＜0.001)水平较无IDH组降低。ApoA1与三酰甘油(r=-0.262,P＜0.001)、C反应蛋白(r=-0.227,P=0.002)、白细胞计数(r=-0.274,P=0.016)及中性粒细胞计数(r=-0.270,P=0.018)呈负相关，与总胆固醇(r=0.294,P＜0.001)、载脂蛋白E(r=0.177,P=0.009)呈正相关；HDL-C与三酰甘油(r=-0.538,P＜0.001)、C反应蛋白(r=-0.150,P=0.044)、白细胞计数(r=-0.193,P=0.005)及中性粒细胞计数(r=-0.192,P=0.005)呈负相关，与总胆固醇(r=0.159,P=0.020)呈正相关。采用ROC曲线分析apoA1和HDL-C预测IDH的准确性，apoA1曲线下面积为0.717(95% CI：0.648～0.787,P＜0.001)，HDL-C曲线下面积为0.686(95% CI:0.615～0.756,P＜0.001)，apoA1最佳临界值(cut-off值)为1.005，HDL-C的cut-off值为1.185。多因素校正后的二元Logistic回归模型(矫正因素包括年龄、性别、体质量指数、高血压病史、糖尿病病史、透析龄、超滤率、透析前降压药、白蛋白、血清前白蛋白、血红蛋白、血肌酐、心脏射血分数、透析前收缩压、透析舒张压)显示低水平apoA1(OR=0.012,95% CI:0.001～0.125，P =0.001)和HDL-C(OR=0.050,95% CI:0.008～0.319，P=0.002)仍是IDH的危险因素。 结论 本研究发现低水平apoA1和HDL-C是IDH的独立危险因素，apoA1和HDL-C对IDH具有潜在的保护作用。

Objective To explore the risk factors for intradialytic hypotension (IDH) from the perspective of lipid metabolism, so as to provide a new basis for the prevention and treatment of hypotension during dialysis. Methods Patients undergoing maintenance hemodialysis at the Blood Purification Center of Maoming People's Hospital from September 2023 to September 2025 were retrospectively enrolled, and clinical data, laboratory test results, and cardiac ultrasound results were collected. IDH was defined as a decrease in systolic blood pressure ≥20 mmHg or a decrease in mean arterial pressure ≥10 mmHg during dialysis, accompanied by symptoms of hypotension requiring nurse intervention (such as drowsiness, lethargy, dizziness, and muscle cramps), occurring ≥1 time per month. Non-IDH group: frequency of intradialytic hypotension ＜1/10 within 3 months; IDH group: at least one hypotensive event per month within 3 months, with frequency of intradialytic hypotension ≥1/10. Pearson or Spearman analysis was used to analyze factors related to apolipoprotein A1 (apoA1) and high-density lipoprotein-cholesterol (HDL-C), and binary logistic regression was used to analyze the risk factors for IDH.  Results  A total of 216 patients were included in this study, with 120 in the non-IDH group and 96 (44.4%) in the IDH group. The levels of HDL-C (t=5.203, P＜0.001) and apoA1 (t=5.571, P＜0.001) in the IDH group were lower than those in the non-IDH group. ApoA1 was negatively correlated with triglycerides (r=-0.262, P＜0.001), C-reactive protein (r=-0.227, P=0.002), white blood cell count (r=-0.274, P=0.016), and neutrophil count (r=-0.270, P=0.018), and positively correlated with total cholesterol (r=0.294, P＜0.001) and apolipoprotein E (r=0.177, P=0.009); HDL-C was negatively correlated with triglycerides (r=-0.538, P＜0.001), C-reactive protein (r=-0.150, P=0.044), white blood cell count (r=-0.193, P=0.005), and neutrophil count (r=-0.192, P=0.005), and positively correlated with total cholesterol (r=0.159, P=0.020). ROC curve analysis was used to assess the accuracy of apoA1 and HDL-C in predicting IDH. The area under the curve for apoA1 was 0.717 (95% CI: 0.648～0.787, P＜0.001), and the area under the curve for HDL-C was 0.686 (95% CI: 0.615～0.756, P＜0.001). The optimal cut-off value for apoA1 was 1.005, and the cut-off value for HDL-C was 1.185. The binary logistic regression model after multivariate adjustment (adjustment factors included age, sex, body mass index, history of hypertension, history of diabetes, dialysis vintage, ultrafiltration rate, pre-dialysis antihypertensive drugs, albumin, serum prealbumin, hemoglobin, serum creatinine, cardiac ejection fraction, pre-dialysis systolic blood pressure, and diastolic blood pressure) showed that low levels of apoA1 (OR=0.012, 95% CI: 0.001～0.125, P=0.001) and HDL-C (OR=0.050, 95% CI: 0.008～0.319, P=0.002) remained risk factors for IDH.  Conclusion This study found that low levels of apoA1 and HDL-C are independent risk factors for IDH, and apoA1 and HDL-C  have potential protective effects against IDH.