| 血液透析患者血压变异性与全因及心脑血管疾病死亡的关系 |
| 投稿时间：2017-01-10 修订日期：2017-01-10 点此下载全文 |
| 引用本文：李秀季,张国娟,姜立萍,郑洁,黄雯.血液透析患者血压变异性与全因及心脑血管疾病死亡的关系[J].医学研究杂志,2017,46(10):116-120 |
| DOI：
10.11969/j.issn.1673-548X.2017.10.030 |
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| 中文摘要:目的 探讨维持性血液透析（maintenance hemodialysis，MHD）患者血压变异性（blood pressure variability，BPV）与全因和心脑血管疾病（cardiac-cerebral vascular disease，CCVD）死亡的关系。方法 选取MHD患者102例，记录临床资料、化验指标及连续10次透析前的血压数值，根据透析前收缩压变异系数（SBP-CV）中位数（7.4%）将患者分为低SBP-CV组（3.3%~7.3%）和高SBP-CV组（7.5%~15.6%）。所有患者随访48个月，记录随访期间MHD患者死亡时间及死因。结果 与低SBP-CV组比较，高SBP-CV组中糖尿病患病比例更高，透析超滤量更大，而血肌酐和血浆白蛋白水平更低（P<0.05）。而两组患者年龄、性别构成比、透析龄、透前收缩压、透前舒张压、血红蛋白、Kt/V以及服用降压药物种类比较，差异均无统计学意义（P>0.05）。在48个月的随访期内，102例MHD患者中死亡39例，其中CCVD死亡19例。低SBP-CV组和高SBP-CV组全因病死率分别为33.3%和43.1%，两组比较差异无统计学意义（P>0.05），而两组CCVD病死率分别为9.8%和27.5%，两组比较差异有统计学意义（P<0.05）。对全因死亡生存曲线进行比较，两组生存率差异无统计学意义（P>0.05）。而对CCVD死亡生存曲线比较，高SBP-CV组生存率显著低于低SBP-CV组，差异有统计学意义（P<0.05）。Cox回归分析显示，高血磷（HR=3.287，90% CI：1.469~7.357）和高C反应蛋白水平（HR=1.026，95% CI：1.007~1.045）是MHD患者全因死亡的独立预测因子（P<0.01），同时高血磷（HR=4.175，95% CI：1.317~13.235）也是CCVD死亡的独立预测因子（P<0.05）。而高血肌酐水平是MHD患者全因（HR=0.996，95% CI：0.994~0.998）及CCVD （HR=0.995，95% CI：0.992~0.997）死亡的保护因子（P<0.01）。结论 高水平透析前SBP-CV可能与增加的CCVD死亡相关，但其并不是CCVD死亡的独立预测因子，而高血磷是全因死亡和CCVD死亡的独立预测因子，血肌酐是保护因子。 |
| 中文关键词:血液透析 血压变异性 死亡 |
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| Relationship between Blood Pressure Variability and All-cause and Cardiac-cerebral Vascular Disease Mortality in Hemodialysis Patients |
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| Abstract:Objective To investigate the relationship between blood pressure variability (BPV) and all-cause and cardiac-cerebral vascular disease (CCVD) mortality in maintenance hemodialysis (MHD) patients. Methods Totally 102 stable MHD patients were recruited in Dialysis Center of Beijing Tongren Hospital. The general data and pre-dialytic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. The pre-dialytic SBP coefficient of variation (CV) was used as an indicator of BPV. MHD patients were divided into the low SBP-CV group (3.3%-7.3%) and the high SBP-CV group (7.5%-15.6%) according to the median of SBP-CV (7.4%). All patients were followed up for 48 months. The time and cause of death were recorded during this period. Results In the high SBP-CV group, the rate of diabetes and ultrafiltration volume were significantly increased (P<0.01), and the pre-dialytic levels of serum creatinine and plasma albumin were significantly deceased compared with the low SBP-CV group (P<0.05). There were no significant differences in age, ratio of sex, dialytic age, pre-dialytic SBP, pre-dialytic DBP, hemoglobin, Kt/V and the types of taking antihypertensive drugs between the two groups (P>0.05). During the follow-up period, 39 died in the 102 MHD patients. Among them 19 died of CCVD and accounted for 48.7% of the total mortality. All-cause mortality in the low SBP-CV group and the high SBP-CV group was 33.3% and 43.1% (P>0.05). CCVD mortality was 9.8% and 27.5% (P<0.05). There was no significant difference in survival curves of all-cause mortality between the two groups (P>0.05). The survival curves for CCVD mortality was significantly lower in the high SBP-CV group than in the low SBP-CV group (P<0.05). By Cox regression analysis, high blood phosphate (HR=3.287,95%CI:1.469-7.357) and C-reactive protein (HR=1.026, 95%CI:1.007-1.045) levels were independent predictors of all-cause mortality in MHD patients (P<0.01), meanwhile high blood phosphate levels (HR=4.175, 95%CI:1.317-13.235) were also an independent predictor of CCVD mortality (P<0.05). However, high serum creatinine levels were a protective factor of all-cause (HR=0.996, 0.994-0.998) and CCVD (HR=0.995, 95%CI:0.992-0.997) mortality (P<0.01). Conclusion Greater pre-dialytic SBP variability may be associated with increased CCVD mortality,but it is not an independent predictive factor of CCVD mortality. High blood phosphate levels should be an independent predictor of all-cause and CCVD mortality and high serum creatinine should be a protective factor. |
| keywords:Hemodialysis Blood pressure variability Mortality |
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