维持性血液透析患者脉压及脉压指数与心血管疾病事件的相关性研究

Correlation between Pulse Pressure,Pulse Pressure Index and Cardiovascular Disease Events among Patients Undergoing Maintenance Hemodialysis

目的探讨维持性血液透析（MHD）患者脉压及脉压指数与心血管疾病（CVD）事件的相关性,观察脉压及脉压指数对CVD事件的预测价值。方法选择2012年5月—2013年5月在南京大学医学院附属鼓楼医院血液透析中心规律行MHD且病情稳定的患者86例,测量血压,计算脉压及脉压指数。根据有无CVD事件分为CVD组和非CVD组,根据脉压分为：≤40 mm Hg,41-60 mm Hg,61-80 mm Hg,〉80 mm Hg;根据脉压指数分为：≤0.30,0.31-0.40,0.41-0.50,〉0.50。采用单因素和多因素Logistic回归法分析MHD患者发生CVD事件的影响因素。结果CVD组与非CVD组年龄、透析时间、收缩压、脉压、脉压指数、血糖、肾小球滤过率（eGFR）比较,差异均有统计学意义（P〈0.05）。不同脉压水平患者年龄、透析时间、收缩压、舒张压、脉压指数、eGFR及CVD事件发生率比较,差异均有统计学意义（P〈0.05）。不同脉压指数患者年龄、透析时间、收缩压、舒张压、脉压及CVD事件发生率比较,差异均有统计学意义（P〈0.05）。单因素Logistic回归分析结果显示：透析时间、脉压、脉压指数、血红蛋白与MHD患者CVD事件有关（P〈0.05）。多因素Logistic回归分析结果显示：透析时间、脉压、脉压指数、血红蛋白与MHD患者发生CVD事件有回归关系（P〈0.05）。结论透析时间长、脉压大、脉压指数大、贫血是MHD患者发生CVD事件的独立危险因素。临床上通过监测MHD患者脉压及脉压指数,早期、客观、准确地控制血压,可降低MHD患者CVD事件的发生率。

Objective To investigate the correlation between pulse pressure（PP）,pulse pressure index（PPI） and cardiovascular disease（CVD） events among patients undergoing maintenance hemodialysis（MHD）,and to observe the value of PP and PPI in predicting CVD events.Methods A total of 86 patients undergoing regular MHD at hemodialysis center in Nanjing Gulou Hospital Affiliated to Medical College of Nanjing University from May 2012 to May 2013 were selected as study subjects,blood pressure was measured,PP and PPI were calculated.According to the presence of CVD events,the patients were divided into CVD group and non- CVD group.According to PP,the patients were divided into four groups：≤40 mm Hg group,41- 60 mm Hg group,61- 80 mm Hg group, 80 mm Hg group.According to PPI,the patients were divided into following four groups：≤0.30 group,0.31- 0.40 group,0.41- 0.50 group, 0.50 group.The influence factors of CVD events among patients undergoing MHD were analyzed by univariate and multivariate Logistic regression analysis.Results There were significant differences in age,dialysis duration,systolic blood pressure,PP,PPI,blood glucose level and eGFR between CVD group and non- CVD group,the difference was significant（P〈0.05）.There were significant differences in age,dialysis duration,systolic blood pressure,diastolic blood pressure,PPI,eGFR and incidence of CVD events among groups with different PP levels,the difference was significant（P〈0.05）.There were significant differences in age,dialysis duration,systolic blood pressure,diastolic blood pressure,PP and incidence of CVD events among groups with different PPI levels,the difference was significant（P〈0.05）.Univariate Logistic regression analysis results showed that the dialysis time,PP,PPI and hemoglobin level were associated with CVD events in MHD patients（P〈0.05）.According to the results of further multivariate Logistic regression analysis,there was a regression relationship between CVD events and dialysis time,PP,PPI,hemoglobin level（P〈0.05）.Conclusion Long dialysis time,high PP and PPI,and anemia are independent risk factors for CVD events in MHD patients.Through clinical monitoring PP and PPI in MHD patients,controlling blood pressure early,objectively and accurately,the incidence of CVD events in MHD patients can be reduced.