维持性血液透析患者的容量负荷分布及其与血压关系的多中心研究被引量：1

A multicenter study of the relationship between fluid status assessed by bioimpedance analysis and blood pressure in maintenance hemodialysis patients

下载PDF

导出

摘要目的利用生物电阻抗分析(bioimpedance analysis,BIA)测量容量负荷,同期测量居家血压(home blood pressure,HBP),探讨维持性血液透析(maintenance hemodialysis,MHD)患者容量负荷分布情况及其与血压的关系。方法北京市7个血液净化中心MHD的患者共113人,BIA测患者的多余水分(overhydration,OH),计算每周的时间平均容量负荷(weekly time-averaged overhdration,wTAOH),依据wTAOH分4组,容量不足组(组1,wTAOH<-0.25L)、容量负荷正常组(组2,-0.25L≤wTAOH≤1.25L)、容量超负荷组(组3,1.25L<wTAOH≤2.8L)、容量严重超负荷组(组4,wTAOH>2.8L),比较4组居家收缩压(home systolic blood pressure,HSBP)及相关指标差异;当周测量HBP并依据135≥HSBP≥160mmHg对患者血压分级:1级(HSBP<135mmHg)、2级(135mmHg≤HSBP<160mmHg)、3级(HSBP≥160mmHg);对wTAOH与HSBP进行Pearson相关分析。结果MHD患者中,组3占28.3%,组4占18.6%,组2占40.7%,组1占12%;HSBP2级和3级占70%,其中3级占28.4%,1级占30%;将wTAOH与HSBP进行Pearson相关分析,结果显示两者存在正相关(r=0.200,P=0.033);组4的HSBP高于组2和组3(t值分别为2.773,2.051;P值分别为0.007,0.043),但与组1无显著差异。结论容量超负荷在MHD患者中仍普遍存在;血压虽然与容量负荷相关,但不能准确反映MHD患者的容量负荷,尤其是在容量不足和正常的时候。 Objective Bioimpedance analysis(BIA)was used to evaluate volume load and the blood pressure(BP)at home was measured at the same time to study the relationship between fluid status and BP in maintenance hemodialysis(MHD)patients.Methods A total of 113 MHD patients in the 7 blood purification centers in Beijing were enrolled in this study.BIA was used to measure the overhydration(OH)status and to calculate the weekly timEaveraged overhydration(wTAOH).The patients were then assigned into 4 groups:the dehydration group(group 1,wTAOH less than-0.25L),the normohydration group(group 2,≤-0.25L wTAOH≤1.25L),the overhydration group(group 3,<1.25L wTAOH≤2.8L),and severe overhydration group(group 4,wTAOH>2.8L).The home systolic blood pressure(HSBP)and the related parameters were compared among the 4 groups.The patients were divided into 3 categories based on the HSBP in a week:class 1(HSBP<135mmHg),class 2(≤135mmHg HSBP<160mmHg)and class 3(HSBP≥160mmHg).Pearson correlation analysis was used to investigate the relationship between wTAOH and HSBP.Results BIA found that the rates of MHD patients with overhydration(group 3)and severe overhydration(group 4)were 28.3%and 18.6%,respectively;the rates of the patients with normohydration(group 2)and dehydration(group 1)were 40.7%and 12%,respectively.The MHD patients in class 1(HSBP<135mmHg),class 2(≤135mmHg HSBP<160mmHg)and class 3(HSBP>160mmHg)were 30.0%,41.6%and 28.4%,respectively.Pearson correlation revealed that wTAOH was positively correlated with HSBP(r=0.200,P=0.033).The HSBP was higher in group 4 than in groups 2 and 3(156.0±16.9 vs.143.0±17.5mmHg,t=2.773,P=0.007 for group 4 vs.group 2;156.0±16.9 vs.145.7±18.5mmHg,t=2.051,P=0.043 for group 4 vs.group 3)but had no statistical significance between groups 4 and 1.Conclusion Overhydration is prevalent in MHD patients.BP is positively correlated with overhydration.However,BP cannot accurately reflect volume load status,especially the normohydration and dehydration status,in MHD patients.

作者张周沧甘良英李忠心马迎春秦燕康志敏齐桂静朱丽杨帆王欣欣薛宇房艳辉郭兴斌杨清华苏香彪张东亮王梅 ZHANG Zhou-cang;GAN Liang-ying;LI Zhong-xin;MA Ying-chun;QIN Yan;KANG Zhi-min;QI Gui-jing;ZHU Li;YANG Fan;WANG Xin-xin;XUE Yu;FANG Yan-hui;GUO Xing-bin;YANG Qing-hua;SU Xiang-biao;ZHANG Dong-liang;WANG Mei(Blood Purification Center,Department of Nephrology,Peking University International Hospital,Beijing 102206,China;Department of Nephrology,Peking University People’s Hospital,Beijing 100044,China;Central for Kidney Disease,Beijing Luhe Hospital,Capital Medical University,Beijing 101100,China;Department of Nephrology,Beijing Bo’ai Hospital,China Rehabilitation Research Center,School of Rehabilitation Medicine,Capital Medical University,Beijing 100068,China;Department of Nephrology,Beijing Geriatric Hospital,Beijing 100095,China;Department of Nephrology,Aviation General Hospital,Beijing 100012,China;Department of Nephrology,Beijing Changping Hospital,Beijing 102200,China)