持续非卧床腹膜透析患者容量超负荷与脉压的关系

Association between Fluid Overload and Pulse Pressure in Patients on Continuous Ambulatory Peritoneal Dialysis

目的探讨持续性非卧床腹膜透析(简称腹膜透析)患者细胞外液与总体液的比率(简称E/T比率)与脉压的关系。方法选取同一中心74例情况稳定的腹膜透析患者为研究对象。测量肱动脉血压得出脉压。应用多频生物电阻抗分析仪对患者的容量状态进行评估,得出E/T比率。同时应用标准测量法进行相应生物化学检查。对相应指标进行相关及多元回归分析以判断相应指标之间的关系,筛选脉压的影响因素。结果Pearson相关分析发现脉压与E/T比率(r=0.691,P<0.001)、细胞外液与细胞内液之比(r=0.695,P<0.001)、收缩压(r=0.78,P<0.001)、舒张压(r=-0.402,P<0.001)、年龄(r=0.427,P<0.001)、血清白蛋白(r=-0.36,P=0.002)、C反应蛋白(r=0.367,P=0.008)和糖尿病状态(r=0.25,P=0.031)显著相关。多元线性逐步回归结果发现E/T比率(β=0.67,P<0.001)和C反应蛋白(β=0.253,P=0.016)是脉压增加的独立危险因素。二者一起决定了脉压变化的55.7%。其中仅E/T比率就决定了脉压变化的50.4%。回归方程为Y=-111.81+326.361X1+0.584X2(Y为脉压,X1为E/T比率;X2为C反应蛋白)。结论腹膜透析患者中E/T比率增加与脉压的增大密切相关。E/T比率同C反应蛋白一起是腹膜透析患者脉压增大的独立危险因素。

Aim To research the assesiation between E/T （ extracellular water to-total body water ratio） and pulse pressure （PP） in patients on continuous ambulatory peritoneal dialysis （ CAPD）. Methods Clinical stable CAPD patients （ n = 74, 32M/42F） were included. Brachial blood pressure was measured twice in sitting position after patients had rested mere than ten minutes. PP was calculated as systolic blood pressure （ SBP） minus diastolic blood pressure （ DBP） and it was used as an index of large arterial stiffness. Multiple-frequency bioelectrical impedance analysis was used to record the values for ECW, intracellular water （ICW）, and total-hody water. Based on these data, E/T also was calculated. In addition, some biochemical indices were determined with standard methods. Results PP was strongly associated with E/T （extracellular water/total body water） （r=0.691, P〈0.001）, E/I （extracellular water/intracellular water） （r=0.456, p=0.001）, SBP（r=0.78,P〈0. 001）, DBP, （r= -0.402, P〈0.001）, age （r=0.427, P〈0.001）, serum albumin （r= -0.36, P=0.002）, C-reactlve protein（CRP） （ r = 0.367, P = 0.008） and diabetes （ r = 0.25, P = 0.031 ）, respectively. Multiple regression analysis showed that PP was independently determined by E/T （β=0.67,P 〈0.001）and CRP （β=0.253, P=0.016）. They accounted for 55.7 % of the total variance and E/T alone reprensented 50.4% of the explained variance. The regression equation： Y = - 111. 81 ＋ 326.361X1 ＋ 0.584X2（Y = PP;X1 = E/T;X2 = CRP）. Conclusion E/T was closely associated with PP in peritoneal dialysis patients. E/T, in addition to CRP,was an independent risk factor for elevated PP in CAPD patients,suggesting that increased arterial stiffness might be the link between fluid overload and cardiovascular events and mertality in dialysis patients.