大动脉脉冲速率对终末期肾功能衰竭维持性血液透析患者预后的影响

Effects of aortic pulse wave velocity on prognosis of patients with end-stage renal failure undergoing maintenance hemodialysis

目的:分析随血压水平下降相应的动脉脉冲速率(PWV)的变化对终末期肾功能衰竭(ESRF)患者预后的意义。方法:52例维持性血液透析患者,年龄(62±13)岁,共观察(17±9)个月,观察伴随血压下降PWV的变化,通过调整干体重控制患者血压水平,共有12例患者死亡,其中7例死于心血管并发症,5例死于非心血管并发症。结果:Cox分析结果提示(1)随血压水平下降,PWV水平保持不变(无相应下降);(2)左心室容积增加;(3)年龄大;(4)存在基础心脏原发病,是不依赖于患者血压水平变化而独立影响患者病死率的因素。随血压变化PWV水平保持不变的病例死亡的危险系数为0.288(95%可信区间0.084～0.987),P<0.05。结论:对于ESRF患者,随血压水平下降,动脉PWV变化不明显能作为ESRF维持性血液透析患者远期病死率指示标准。

Objective To observe the effects of aortic pulse wave velocity （PWV） on prognosis of patients with end-stage renal failure （ESRF） undergoing maintenance hemodialysis. Methods The changes of PWV with the decreasing blood pressure in 52 patients aged （62 ±13）years undergoing maintenance hemodialysis were monitored for （17 ± 9） months. BP was controlled by adjusting patient＇s dry weight. Results 12 deaths occurred, including 7 from cardiovascular complications and 5 from other complications. Cox analyses suggested that maintenance of PWV in response to a decrease in BP, increased left ventricular volume, age, and preexisting cardiovascular disease were the independent factors for affecting mortality rate which were not dependent on the changes of BP. The risk ratio of death was 0.288 in those with maintenance of PWV responsive to a decline in BP （95% CI 0.084 to 0.987,P 〈 0.05）. Conclusion Nonsignificant changes in aortic PWV with a declining BP can be used as a predictor for the long-term mortality in patients with ESRF undergoing maintenance hemodialysis.