中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (08): 514-518.doi: 10.3969/j.issn.1671-4091.2018.08.003

• 临床研究 • 上一篇    下一篇

维持性血液透析患者透析前后体液分布特点及与血压、左心室肥厚相关性分析

朱丽1,甘良英1,蔡美顺1,杨冰1,赵新菊1   

  1. 1.  北京大学人民医院肾内科
  • 收稿日期:2018-06-07 修回日期:2018-06-07 出版日期:2018-08-12 发布日期:2018-08-12
  • 通讯作者: 甘良英 ganliangying@yahoo.com E-mail:ganliangying@yahoo.com
  • 基金资助:

    北京市科学技术委员会首都临床特色应用研究支持项目(Z131107002213122)

Relationship between body fluid distribution, blood pressure and left ventricular hypertrophy before and after hemodialysis sessions in maintenance hemodialysis patients

  • Received:2018-06-07 Revised:2018-06-07 Online:2018-08-12 Published:2018-08-12

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摘要： 【摘要】目的应用生物电阻抗技术研究维持性血液透析患者(maintenance hemodialysis，MHD)透析前后体液分布特点及与血压、左心室肥厚(left ventricular hypertrophy,LVH)的关系。方法入选北京大学人民医院MHD 患者99 人，无显性水肿，近期无严重感染、心力衰竭等。应用生物电阻抗分析仪测量患者透析前后总体液(total body water,TBW)、细胞外液(extracellular water,ECW)和细胞内液(intracellular water,ICW)，记录患者透析前血压及超声心动图等数据。应用Pearson 分析超滤量与透析前后体液变化的相关性；Logistics 回归分析影响患者高血压、左心室肥厚等的相关因素。结果①入选99 例MHD 患者(男/女：60/39)，年龄中位数61.00(47.00～69.00)岁，透析龄中位数63.00(39.00～118.00)月。原发病慢性肾小球肾炎40 例，高血压肾损害19 例，糖尿病肾病17 例，其他22 例，病因不详1 例。②临床评估透析后达到干体质量的患者，经生物电阻抗测量仍有22.2%透析后容量负荷过重。③透析前后ΔECW 与超滤量高度正相关(r=0.822,P＜0.001)，ΔTBW 与超滤量中等强度正相关(r=0.594,P＜0.001)，而ΔICW 与超滤量弱度正相关(r=0.210,P=0.037)。④透析前ECW/TBW(P=0.023，OR=1.187，95% CI 1.024～1.377)、透析后ECW/TBW(P=0.019，OR=1.156，95% CI 1.024～1.306)、全段甲状旁腺激素(intact parathyroid hormone,iPTH)(P=0.021OR=1.005, 95% CI 1.001～1.010)为透析前高血压的独立危险因素。⑤透析后ECW/体质量(P=0.041，OR=1.196，95% CI 1.007～1.420)、女性(P=0.026，OR=0.358，95% CI 0.145～0.882)、iPTH(P=0.014，OR=1.004，95%CI 1.001～1.006)、透析前高血压(P=0.045，OR=3.177，95% CI 1.026～9.842)为维持性血液透析患者LVH 的独立危险因素。LVH 组透析间期体质量增长率有高于非LVH 组趋势(4.45±1.68 比3.86±1.50,t=1.859,P=0.066)。结论容量负荷过重为血液透析患者高血压及左心室肥厚的独立危险因素；透析间期体质量增长过高可能与左心室肥厚相关。

关键词: 血液透析, 生物电阻抗, 高血压, 左室肥厚

Abstract: 【Abstract】Objective To explore the relationship between body fluid distribution, blood pressure and left ventricular hypertrophy (LVH) before and after hemodialysis sessions in maintenance hemodialysis (MHD) patients by using bioelectrical impedance technique. Methods A total of 99 MHD patients without obvious edema, recent severe infection and heart failure were recruited from Peking University People's Hospital. The total body water (TBW), extracellular water (ECW) and intracellular water (ICW) before and after dialysis were measured by a bioelectrical impedance analyzer. Blood pressure and echocardiography of the patients were recorded. Logistics regression analysis was used to identify risk factors for hypertension and LVH. Results ①A total of 99 MHD patients (60 males and 39 females) with the dialysis vintage of 63 (39.00～118.00) months were enrolled in this study. ② In patients reached dry body weight after dialysis by clinical evaluation, 22.2% of them were still overloaded by bioelectrical impedance analysis. ③ΔECW was positively and closely correlated to ultrafiltration volume (r=0.822, P＜0.001); ΔTBW was positively correlated to ultrafiltration volume (r=0.594, P＜0.001); while ΔICW only had a weak correlation to ultrafiltration volume (r=0.210, P=0.037). ④ECW/TBW before dialysis (P=0.023, OR=1.187, 95% CI 1.024～1.377), ECW/TBW after dialysis (P=0.019, OR=1.156, 95% CI 1.024～1.306), and intact parathyroid hormone (iPTH) (P=0.021, OR=1.005, 95% CI 1.001～1.010) were the risk factors for hypertension before dialysis. ⑤ECW/body weight after dialysis (P=0.041, OR=1.196, 95% CI 1.007～1.420), female (P=0.026, OR=0.358, 95% CI 0.145～
0.882), iPTH (P=0.014, OR=1.004, 95% CI 1.001～1.006), and hypertension before dialysis (P=0.045, OR=3.177, 95% CI 1.026～9.842) were significantly correlated to LVH. The weight gain rate in the interphase of hemodialysis sessions was higher in LVH group than in non-LVH group (4.45±1.68 vs. 3.86± 1.50, t=1.859,P= 0.066). Conclusions Volume overload is an independent risk factor for hypertension and LVH in MHD patients. The higher weight gain rate in the interphase of hemodialysis sessions may associate with LVH.

Key words: Hemodialysis, Bioelectrical impedance analysis, Hypertension, Left ventricular hypertrophy