血液透析患者动脉弹性功能及相关因素分析

Assessment of arterial stiffness in patients subject to maintenance hemodialysis and relative factors

目的探讨维持性血液透析（MHD）患者在血液透析前、后脉搏波速度（PWV）和压力反射波增强指数（AIx）水平变化及其相关因素。方法选择92例MHD患者，采用标准袖带水银血压计测量非动脉一静脉内瘘侧上臂坐位血压，动脉脉搏波分析仪检测动脉弹性指数AIx和PwV，并分别与各因素进行单因素相关分析和多元逐步回归分析。结果血液透析患者的袖带血压、中心动脉压、PWV和AIx在血液透析前后均无显著性变化（P〉0．05）；多元逐步回归分析表明，AIx与患者的年龄、性别、主动脉收缩压有明显相关（P〈0．05），而PWV与患者年龄、上臂舒张压、钙磷乘积、身高、透析时间和心率存在明显相关（P〈0．05）；PWV与AIx之间有明显相关（P〈0．05）。结论（1）血液透析患者的AIx与PWV、中心动脉压收缩压（C_SP）、身高、血清白蛋白、性别和年龄存在相关关系，其中与PWV、性别、年龄和C_SP呈正相关；而与身高和血清白蛋白呈负相关。（2）血液透析患者的PWV与AIx、年龄、舒张压、钙磷乘积、身高、透析时间和心率存在相关关系，其中与AIx、年龄、钙磷乘积、舒张压、透析时间及心率呈正相关，仅与身高呈负相关。

Objective To investigate the changes of pulse wave velocity （PWV） and augmentation index （Aix） in patients subject to maintenance hemodialysis （MHD） before and after hemodialysis and their correlation with clinical factors. Methods Ninety-two MHD patients were enrolled. Arm sitting blood pressure of non-arteriovenous internal fistula sides was measured by the standard cuff mercury sphygmomanometer,and arterial elastic index AIx and PWV by SphygmoCor artery pulse wave analyzer. Various factors were analyzed by single factor correlation analysis and multiple stepwise regression- Results There was no significant difference in cuff blood pressure, central aortic pressure, PWV,and AIx before and after a single hemodialysis session in MHD patients （P〉0. 05）. Multiple stepwise regression analysis showed that AIx was related to age, gender and systolic aortic pressure, PWV related to age, arm diastolic blood pressure, calcium-phosphorus product, height, MHD years and heart rate （P〈0.05）, and PWV related to Aix（P〈0.05）. Conclusions （1）AIx was positively correlated to PWV and central systolic pressure, but negative to height and albumin. （2）PWV was positively correlated to Aix, age, calcium-phosphorus product, but negatively to height.