中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (06): 416-420.doi: 10.3969/j.issn.1671-4091.2024.06.004

• 临床研究 • 上一篇    下一篇

透析充分性对维持性血液透析患者血压变异性和血管钙化的影响

游奴佳    熊于勤    刘 瑶    马 秋    廖若西    吴 玲     凌子瀛    于 洋   

  1. 610041 成都，1四川大学华西公共卫生学院(华西第四医院)/华西护理学院
    610041 成都，2四川大学华西公共卫生学院(华西第四医院)中毒/肾脏内科
    610041 成都，3四川大学华西医院肾脏内科/华西肾脏病研究所
    409000 重庆，4重庆大学附属黔江医院肾内科
  • 收稿日期:2024-01-02 修回日期:2024-03-11 出版日期:2024-06-12 发布日期:2024-06-12
  • 通讯作者: 于洋 E-mail:yuyang@wchscu.cn
  • 基金资助:
    国家自然科学基金青年科学基金(82200837)

Impact of dialysis adequacy on blood pressure variability and vascular calcification in patients undergoing maintenance hemodialysis

YOU Nu-jia, XIONG Yu-qin, LIU Yao, MA Qiu, LIAO Ruo-xi, WU Ling, LING Zi-ying, YU Yang   

  1. West China School of Nursing, Sichuan University, Chengdu 610041, China; 2Department of Toxicology and Nephrology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China; 3Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China; 4Department of Nephrology, Chongqing University Qianjiang Hospital, Chongqing 409000, China
  • Received:2024-01-02 Revised:2024-03-11 Online:2024-06-12 Published:2024-06-12
  • Contact: 610041 成都，3四川大学华西医院肾脏内科/华西肾脏病研究所 E-mail:yuyang@wchscu.cn

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摘要： 目的  探究透析充分性与维持性血液透析患者心血管结构功能指标的关系。 方法  回顾性收集四川大学华西第四医院门诊维持性血液透析患者的临床资料及连续12次透析治疗的血压(blood pressure,BP)。将血清尿素下降率(urea reduction rate,URR)≥65%及单室尿素清除率(single-pool urea clearance,spKt/V)≥1.2定义为充分透析。计算最大和最小BP差值(△BP)、平均实际变异(average real variation,ARV)等指标。采用多变量逐步线性回归和二元Logistic回归分析探索透析充分性对血压变异性、冠状动脉钙化等心血管并发症的影响。 结果  共纳入90例患者，年龄(59.8±17.4)岁，中位透析龄28.3(12.3，46.8)月。透析不充分者(45例)较充分者(45例)的透析期收缩压△BP(t=  
-2.035,P=0.045)、收缩压ARV(t=-2.228,P=0.028)及冠状动脉钙化积分(t=-2.045,P=0.041)更高。年龄(β=0.305,P=0.003)、冠心病(β=-0.255,P=0.014)、spKt/V(β=-0.290,P=0.006)与透析期收缩压ARV水平相关。糖尿病(OR=6.048,95% CI：1.168～31.330,P=0.032)、低白蛋白水平(OR=0.817,95% CI：0.681～0.982,P=0.031)、低spKt/V(OR=0.886,95% CI：0.786～0.998,P=0.047)是钙化积分≥400的独立危险因素。 结论  透析不充分与维持性血液透析患者透析期收缩压变异性增高密切相关，并且是严重冠状动脉钙化的独立危险因素。

关键词: 血液透析, 透析充分性, 血压变异性, 冠状动脉钙化, 左心室肥厚

Abstract: Objective To explore the relationships between dialysis adequacy and cardiovascular structure and function in patients with maintenance hemodialysis (MHD).  Methods  Clinical data with respect to blood biochemical examinations, vascular calcification and 12 consecutive dialysis treatments were retrospectively collected for patients receiving hemodialysis more than three months. Adequate dialysis was defined as the urea reduction rate (URR)≥65% and single-pool urea clearance (spKt/V)1.2. Blood pressure variability (BPV) metrics including the difference in maximum and minimum BPs (△BP) and average real variation (ARV) were calculated, and multivariate regression analyses were conducted.  Results  A total of 90 Chinese MHD outpatients were included, with the mean age of 59.8±17.4 years and the median dialysis vintage of 28.3(12.3～46.8) months. Patients with inadequate dialysis (45 patients) had higher intradialysis systolic ΔBP (27.9±6.6 vs. 25.1±6.5 mmHg, t=-2.035, P=0.045) and systolic BP-ARV [SBP-ARV (13.4 ± 3.4) vs. (11.9 ± 3.2)mmHg, t=-2.228, P=0.028] and greater coronary artery calcification score [CACs, 461.0(96.0～1741.0) vs. 99.5(1.0～1329.0), t=-2.045, P=0.041] than those with adequate dialysis (45 patients). Age (β=0.305, P=0.003), coronary heart disease (β= -0.255, P=0.014) and spKt/V (β= -0.290, P=0.006) were significantly correlated with intradialysis SBP-ARV; diabetes mellitus (OR= 6.048, 95% CI:1.168～31.330, P=0.032), low serum albumin levels (OR=0.817, 95% CI:0.681～0.982, P=0.031) and spKt/V (OR=0.886, 95% CI:0.786～0.998, P=0.047) were found to be independent risk factors for CACs≥400.Conclusions Inadequate dialysis was strongly associated with elevated intradialysis BPV and increased risk of severe coronary artery calcification in MHD patients.

Key words: Hemodialysis, Dialysis adequacy, Blood pressure variability, Coronary artery calcification, Left ventricular hypertrophy

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