摘要
目的了解终末期肾病（ESRD）患者血液透析过程中血压变异性（BPV）特点，分析BPV的影响因素。方法入选规律血液透析且临床判断干体质量达标的患者81例，应用动态血压监测仪行围透析期血压监测。BPV用收缩压变异系数（SBP．CV）和标准差（SBP．SD）表示。根据SBP．CV均值将患者分成高收缩压变异性（SBPV）组和低SBPV组，对可能的影响因素年龄、透析龄、脱水量、失重比、降压治疗、电解质、营养水平、矿物质骨代谢指标、炎性标志物、血脂等进行分析，比较组间差异；并分别对上述观察指标与SBP—CV、SBP—SD行多因素多元逐步回归分析。结果81例患者围透析期SBP．CV均值为（8．12±3．16）％，SBP—SD均值为（11．22±4．55）mmHg。高SBPV（SBP—CV≥8．12％）组发生透析中高血压和低血压的比例（20．0％和25．7％）均高于低SBPV（SBP—CV〈8．12％）组（8．7％和6．5％）（P=0．009）。高SBPV组透前高敏C反应蛋白（hs—CRP）和碱性磷酸酶（ALP）高于低SBPV组，差异有统计学意义f（7．19±5．95）mg／L比（3．35±2．78）mg／L，P=0．001；（180．31±96．32）U／L比（98．00±41．19）U／L，P=0．049]。低SBPV组透前血肌酐、血钾高于高SBPV组，差异亦有统计学意义【（1015．83±276．20）μmol／L比（893．63±216．61）μmol／L，P=0．034；（5．27±0．78）mmol／L比（4．80±0．23）mmol／L，P=0．005】。多因素多元逐步回归分析发现血液透析过程中SBP—SD与Hs—CRP呈正相关（β=0．499，P〈0．01），SBP—CV与Hs—CRP、透析龄呈正相关（β=0．464和0．211，P〈0．01和P〈0．05）。结论ESRD患者在血液透析过程中SBPV为8．12％，SBPV高的患者更容易发生透析中高瓶压和低血压，SBPV与血清hs-CRP水平密切相关。
Objective To understand the blood pressure variability （BPV） and the influencing factors through ambulatory blood pressure monitoring during hemodialysis （HD） in the end-stage renal disease （ESRD） patients. Method Eighty-one ESRD patients on maintenancing HD for more than three months were enrolled into the study. The patients were with properly dry body weight. The blood pressure was monitored using dynamic blood pressure monitor around the HD. BPV was estimated with the coefficient of variation （CV） and standard deviation （SD） of the systolic blood pressure （SBP-CV, SBP-SD）. Patients were divided into two groups according to the mean of SBP-CV： high SBPV group and low SBPV group. The possible influencing factors such as age, dialysis duration, uhrafihration volume, uhrafihration/body weight, therapy of antihypertensive, electrolyte, nutrition state, metabolic bone disease indexes, inflammatory state and serum lipid state were analyzed and compared between the two groups. And multivariate stepwise regression analysis was made between the SBP-CV, SBP-SD and the above observational parameters. Results The average SBP-CV of the 81 patients was （8.12±3.16）%, SBP-SD was （11.22±4.55） mm Hg. The proportion of hypertention and hypotention in high SBPV（SBP-CV≥8.12%） group （20.0%, 25.7%） was higher than that in the low SBPV（SBP-CV 〈 8.12%） group （8.7%, 6.5%）（P = 0.009）. Serum high- sensitivity c- reactive protein （hs- CRP） and alkaline phosphatase （ALP） were higher in high SBPV group than that in the low SBPV group[（7.19± 5.95） mg/L vs （3.35±2.78） mg/L, P = 0.001 and （180.31±96.32） U/L vs （98.00±41.19） U/L, P = 0.049]. Serum ereatinine and potassium were higher in the low SBPV group than that in the high SBPV group [（1015.83±276.20） μmol/L vs （893.63±216.61） μmol/L, P= 0.034 and （5.27±0.78） mmol/L vs （4.80± 0.23） mmol/L, P = 0.005]. SBP-SD was positively correlated with hs-CRP （β=0.499, P 〈 0.01）, SBP-CV was positively correlated with hs- CRP and dialysis vintage （β = 0.464 and 0.211, P 〈 0.01 and P 〈 0.05） by the multivariate stepwise regression analysis. Conclusions The SBP- CV during HD is 8.12% in ESRD patients. Hypertention and hypotention are more often in the higher SBPV patients. SBPV is closely related to the serum hs-CRP.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2013年第12期888-892,共5页
Chinese Journal of Nephrology
关键词
血液透析
血压
终末期肾病
血压变异性
Hemodialysis
blood pressure
End- stage renal disease
Blood pressure variability
