血液透析患者中透析间期体重增加对脉搏波速的影响

The effect of interdialytic weight gain on pulse wave velocity in hemodialysis patients

目的观察血液透析(hemodialysis,HD)患者中透析间期体重增加(interdialytic weight gain,IDWG)对脉搏波速的影响情况。方法选取北京大学第三附属医院血液透析患者27例,在血液透析结束后以及下一次透析前,分别测量其体重、收缩压、舒张压、细胞外液(extracellular water,ECW)和颈股脉搏波传导速度(carotid-femoral pulse wave velocity,CF-PWV)以评估IDWG及大动脉僵硬度的变化。结果研究人群中,男性患者为12例,女性患者为15例,平均年龄为(61±12)岁。透析间期体重由(62.5±11.2)kg增长至(64.1±11.9)kg(P<0.001)。ECW由(14.0±2.5)L增长至(15.5±3.1)L(P<0.001)。PWV(11.8±1.8)m/s至(10.4±2.0)m/s,(P>0.05)、收缩压与舒张压均未见明显改变。根据IDWG的中位值,患者被分为低IDWG组(n=14)和高IDWG组(n=13),与低IDWG组相比,高IDWG组有较高的体重、ECW和收缩压增长,但PWV的改变(△PWV)仍无统计学意义。Pearson相关分析显示收缩压、舒张压的升高与PWV的增长呈正相关(r=0.554,P<0.01和r=0.537,P<0.01)。以PWV升高或下降为标准,将患者分为PWV下降组(△PWV<0,n=18)和PWV升高组(△PWV≥0,n=9),发现PWV升高组收缩压增加较大(P<0.05),其余指标未见无统计学意义。多元回归分析发现仅有收缩压为PWV的独立影响因素(β=0.039,P<0.005,调整R2=0.268)。分类变量逻辑回归分析,结果同样显示仅有△SBP为PWV升高的独立危险因素(β=0.055,P<0.05),年龄、糖尿病状态和IDWG均被排除在外。结论在透析过程中,IDWG不会导致明显的PWV改变。与年龄、糖尿病状态和IDWG相比,PWV的改变主要受收缩压的影响为主。

Objective To identify the effect of interdialytic weight gain （IDWG） on pulse wave velocity （PWV） in hemodiatysis patients. Methods We recruited 27 hemodialysis patients in this study. Their body weight, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, extracellular water （ECW） by bioimpedance method, and carotid-femoral PWV were measured after a hemodialysis session and before the next session. Results In the 27 patients we tested, 12 were male, 15 were female, and the mean age was （61±12） years. After a hemodialysis session, their body weight increased from （62.5±11.2） kg to （64.1±11.9）kg （P 〈 0.001）, their ECW increased from （14.0±2.5）L to （15.5±3.1）L （P 〈 0.001）, but their SBP, DBP and PWV [（11.0±1.8） m/s to （10.4±2.0）m/s, P〉0.05] did not show any significant changes. These patients were then divided into low IDWG group （n=14） and high IDWG group （n=13） based on the median value of IDWG. In high IDWG group, patients had higher increases of weight, ECW and SBP but without significant change in PWV, as compared with those in low IDWG group. Pearson＇s correlation analysis showed that SBP and DBP elevations were positively correlated with the increase of PWV （r =0.554, P 〈 0.01 and r =0.537, P 〈 0.01, respectively）. Multiple regression analysis revealed that SBP was the single and independent determinant of PWV change （ 13 = 0.039, P 〈 0.005; adjusted R^2=0.268）, while age, diabetes, weight and DBP were excluded from this model. Conclusion During the interdialytic period, IDWG did not cause significant PWV change. Among the factors of age, diabetic status, SBP and IDWG, SBP change was the most important one which affected PWV change.