中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (04): 254-257.doi: 10.3969/j.issn.1671-4091.2021.04.009

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血压波动影响因素分析及其与慢性肾脏病-矿物质和骨异常的相关性研究

何然1,任洁1,印霞1,丁舒1   

  1. 1联勤保障部队第九〇四医院常州医疗区血液透析中心
  • 收稿日期:2020-12-08 修回日期:2021-01-19 出版日期:2021-04-12 发布日期:2021-04-12
  • 通讯作者: 丁舒 15411837@qq.com E-mail:songxmsd77@163.com

The influence factors of blood pressure fluctuation and its correlation with chronic kidney diseasEmineral and bone disorder in maintenance hemodialysis patients

  1. 1Hemodialysis Center of Changzhou Medical District, The 904th Hospital of Joint Logistics Unit, Changzhou 213000, China
  • Received:2020-12-08 Revised:2021-01-19 Online:2021-04-12 Published:2021-04-12

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摘要： 【摘要】目的探究影响维持性血液透析(maintenance hemodialysis，MHD)患者透析期血压波动的因素，并分析血压波动与慢性肾脏病-矿物质和骨异常(chronic kidney disease-mineral and bone disorder，CKD-MBD)的相关性。方法回顾性分析2015 年3 月～2020 年3 月在联勤保障部队第九〇四医院就诊的217 例透析患者资料，根据血压波动情况分为高波动组(n=119)和低波动组(n=98)，比较2 组一般资料、透析参数和生化指标，分析影响血压波动的危险因素，分析血压波动与血清钙、磷、全段甲状旁腺激素 (intact parathyroid hormone，iPTH)和碱性磷酸酶 (alkaline phosphatase，ALP)水平的相关性。结果高波动组的体质量指数(body mass index,BMI)低于低波动组(t=2.077，P=0.039)，透析时间长于低波动组(t=5.043，P＜0.001)，CKD-MBD 患病率高于低波动组(t= 6.663，P=0.010)；高波动组的超滤量、尿素清除指数(Kt/V)小于低波动组(t 值分别为2.213、2.972，P 值分别为0.028、0.003)，25 羟维生素D 水平低于低波动组(t=2.433，P=0.016)，血磷和iPTH 水平高于低波动组(t 值分别为2.868、3.426, P 值分别为0.005、0.001)；透析时间、磷、iPTH 是MHD 患者透析期血压波动的独立危险因素(OR 值分别为1.218，1.294，1.230；95% CI 分别为1.055～1.405，1.058～1.584，1.027～1.473；P 值分别为0.007，0.013，0.025)，Kt/V 是患者血压波动的保护因素(OR=0.225，95% CI: 0.058～0.864, P=0.030)；CKD-MBD 患者的收缩压差值(Δsystolic blood pressure，ΔSBP)明显高于非CKD-MBD 患者(t= 6.764，P＜0.001)；血压波动情况与血磷、iPTH 水平均呈正相关(r 值分别为0.255、0.183，P 值分别为0.029、0.013)。结论透析时间和透析充分性会影响MHD 患者透析期血压波动，且血压高波动与血清磷、iPTH 水平存在相关性，可能参与了MHD 患者CKD-MBD 的发生。

关键词: 肾脏疾病, 维持性血液透析, 血压波动, 慢性肾脏病-矿物质和骨异常, 相关性

Abstract: 【Abstract】Objective To explore the factors affecting intradialytic blood pressure fluctuation in maintenance hemodialysis (MHD) patients, and to analyze the relationship between intradialytic pressure fluctuation and chronic kidney diseasEmineral and bone disorder (CKD-MBD). Methods A total of 217 MHD patients treated in the 904th Hospital of the Joint Logistics Support Force from March 2015 to March 2020 were retrospectively analyzed. They were divided into high fluctuation group (n=119) and low fluctuation group (n=98). The general data, dialysis parameters and biochemical indicators were compared between the two groups. The risk factors for intradialytic blood pressure fluctuation, and the correlation of intradialytic blood pressure fluctuation
with serum calcium, phosphorus, intact parathyroid hormone (iPTH) and alkaline phosphatase (ALP) were then analyzed. Results Compared to the patients in low fluctuation group, patients in high fluctuation group had lower body mass index (BMI) (t=2.077, P=0.039), longer dialysis time (t=5.043, P＜0.001), higher CKD- MBD prevalence (t=6.663, P=0.010), lower ultrafiltration volume and urea clearance index (Kt/V) (t=2.213 and 2.972, P=0.028 and 0.003), lower serum 25- hydroxyvitamin D level (t=2.433, P= 0.016), and higher serum phosphorus and iPTH levels (t=2.868 and 3.426, P=0.005 and 0.001). Dialysis time, phosphorus and iPTH were the independent risk factors for intradialytic blood pressure fluctuation in MHD patients (OR=1.218, 1.294 and 1.230 respectively; 95% CI:1.055~1.405, 1.058~1.584 and 1.027~1.473 respectively;P=0.007, 0.013 and 0.025 respectively); Kt/V was a protective factor for intradialytic blood pressure fluctuation (OR=0.225, 95% CI: 0.058~0.864, P=0.030). The difference of systolic blood pressure (ΔSBP) was significantly higher in patients with CKD-MBD than those without CKD-MBD (t=6.764, P＜0.001). The intradialytic blood pressure fluctuation was positively correlated with serum phosphorus and iPTH levels (r=0.255 and 0.183, P=0.029 and 0.013). Conclusion Dialysis time and dialysis adequacy affected the intradialytic blood pressure fluctuation in MHD patients. Higher blood pressure fluctuation was correlated with serum phosphorus and iPTH levels, which may be involved in the pathogenesis of CKD-MBD in MHD patients.

Key words: Kidney disease, Maintenance hemodialysis, Blood pressure fluctuation, Chronic kidney diseasEmineral and bone disorder, Correlation

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