维持性血液透析患者脉压及相关因素分析

Pulse pressure directly correlating with the stiffness of large arteries in maintenance hemodialysis patients

目的探讨维持性血液透析(MHD)患者的脉压水平及其相关因素。方法对北京大学人民医院血液净化中心90例MHD患者采用WelchAllyn血压计测定非内瘘侧上肢肱动脉血压并记录。脉压(PP)和平均动脉压(MAP)分别根据收缩压(SBP)-舒张压(DBP)和(SBP+2DBP)/3计算得出。检测患者血生化指标和全段甲状旁腺素(iPTH)水平。采用Complior SP脉搏波速度(PWV)测定仪测定其单次透析前颈动脉-股动脉脉搏波速度(CFPWV)。对MHD患者PP与相关因素进行多元逐步回归。对糖尿病透析患者和非糖尿病透析患者进行独立样本t检验。36例性别、年龄匹配的健康成人作为对照。结果MHD患者PP(59.8±16.8)mmHg(1mmHg=0.133kpa),SBP(140.9±20.4)mmHg,MAP(101.1±14.7)mmHg,CFPWV(13.22±3.23)m/s,均高于正常对照(P<0.05)。多元逐步回归发现,年龄、糖尿病和CFPWV是MHD患者PP的独立影响因素。糖尿病患者SBP、PP及CFPWV明显高于非糖尿病患者(P<0.05),DBP低于非糖尿病患者,但差异无统计学意义。结论维持性血液透析患者脉压明显增加,SBP增高是其主要原因。年龄、糖尿病和CFPWV是脉压的独立影响因素。

Objective Pulse pressure （PP） has been shown as a risk factor for mortality and cardiovascular events in maintenance hemodialysis （MHD） patients. However, the impact of clinical factors on PP and it＇s correlation with pulse wave velocity （PWV） in these patients has not been sufficiently studied. The objective of this study was to investigate PP in MHD patients and it＇s correlation with clinical factors. Methods Ninety MHD patients were enrolled, and 36 sex and age matched healthy people were used as controls. Demographic data were collected. Blood pressure and biochemical parameters were measured. Automatic PWV measuring system was applied to examine carotid-femoral PWV （CFPWV） as the parameter reflecting elasticity and stiffness of large central arteries. Backward multiple linear regression analysis was used to assess the influencing factors of PP. A value of P〈0.05 was regarded as significant. Results PP, systolic blood pressure （SBP）, mean arterial pressure （MAP） and CFPWV in MHD patients were greater than those in healthy controls （59.8±16.8 mmHg vs 47.5±14.7 mmHg; 140.9±20.4 mmHg vs 124.9±15.1 mmHg; 101.1±14.7 mmHg vs 93.3±10.5 mmHg and 13.22±3.23 m/s vs10.67±2.11 m/s, respectively, P〈0.05）. A backward multiple regression analysis demonstrated that age, diabetes mellitus and CFPWV were positively related to PP. The SBP, PP and CFPWV in diabetic MHD patients were significantly higher than those in non-diabetic MHD patients （P 〈0.05）. Conclusions This study demonstrates that PP is elevated in MHD patients due to increased SBP. Age, DM and CFPWV are major determinants of PP. PP in MHD patients correlates significantly with CFPWV which is an aortic stiffness marker.