血液透析患者中心动脉压及动脉僵硬度特点的研究

Characteristics of central aortic pressure and artery stiffness in maintenance hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者中心动脉压(central aortic pressure,CAP)特点及大动脉弹性的变化。方法对40名因终末期肾脏病在北京大学第一医院进行MHD治疗的患者进行肱动脉血压、CAP和增益指数(augmentation index,AI)的测量,并与40名性别和年龄相匹配的非慢性肾脏病患者群指标进行对比。结果无论在非肾脏病患者还是MHD患者,肱动脉收缩压与CAP均有较好的相关性(相关系数分别为0.914和0.926,均P<0.01),但两者差值的平均值为8.9mmHg(1mmHg=0.133kPa),变异大(95%可信区间达28.6mmHg)。年龄<50岁和年龄≥50岁的MHD患者CAP分别为(125±21)mmHg和(138±15)mmHg,均低于相应肱动脉收缩压,但高于非慢性肾脏病患者CAP(均P<0.05)。两年龄组MHD患者AI分别为86%±19%和85%±12%,与非慢性肾脏病患者比较差异无统计学意义(P>0.05),但50岁以下MHD患者AI升高比例高于非慢性肾脏病患者(82%vs35%,P=0.008)。MHD患者AI与CAP相关(r=0.523,P=0.001),与年龄、肱动脉收缩压无相关性。透析后CAP和肱动脉收缩压均降低,而AI不变[(90%±19%)比(86%±16%),P>0.05]。使用动静脉内瘘为血管通路的患者AI高于颈内静脉半永久置管者[(91%±15%)比(76%±10%),P=0.001]。结论维持性血液透析患者的CAP高于同年龄的非肾脏病患者群,中青年MHD患者动脉僵硬度增加的比例明显增高。使用动静脉内瘘的患者动脉僵硬度高于颈内静脉半永久置管者。降低MHD患者CAP和改善大动脉弹性的措施值得进一步探讨。

Objective To investigate the characteristics of central aortic pressure （CAP） and artery stiffness in maintenance hemodialysis （MHD） patients.Methods CAP and augment index （AI） were measured by non-invasive radial artery pulse wave measurement device in 40 MHD patients and 40 non-chronic kidney disease （non-CKD） individuals with the age and gender numbers comparable to MHD patients.Brachial systolic pressure （BSP）,CAP,AI,and difference between BSP and CAP were compared between MHD and non-CKD subjects.Results BSP and CAP were highly correlated in both non-CKD patients （r= 0.914,P0.01） and MHD patients （r=0.926,P0.01）.However,greater difference （8.9 mmHg or 1.18kPa） and variation （95% CI reached to 28.6 mm Hg or 3.8kPa） between SBP and CAP was also found.CAP was 125.4±20.8 mm Hg in MHD younger than 50 years old,and （138.4±15.0） mm Hg in those more than 50 years old,lower than their respective BSP but higher than the CAP in non-CKD patients （P0.05）.AI was （85.5±18.5）% in MHD younger than 50 years old and （84.6±12.1）% in those more than 50 years old,without significant differences as compared with the AI in non-CKD patients （P 0.05）.The percentage of increased AI was higher in MHD under 50 years old （82%） than non-CKD （35%,P=0.008）.In MHD patients,AI was moderately correlated to CAP （r=0.523,P=0.001）,but not to their age （r=0.137,P0.05） and BSP （r=0.200,P0.05）.In MHD patients after hemodialysis session,CAP and BSP decreased but not AI （89.6±18.7% vs.86.0±15.9%,P=0.212）.AI value was higher in patients with internal arteriovenous fistula than in those with cuffed-catheterization [（90.8±15.0）% vs.（76.2±10.3）%,P=0.001].Conclusion The increase of CAP and artery stiffness was observed in MHD patients.Further research is needed to observe whether treatments for decrease of CAP and improvement of artery stiffness are useful for MHD patients.