平均实际血压变异对于维持性血液透析患者临床心血管预后的预测价值

Prognostic value of average real variability of interdialytic blood pressure in maintenance hemodialysis patients

目的 本文拟评估血压变异度指标—平均实际变异（average real variability,ARV）对判断维持性血液透析（maintenance hemodialysis,MHD）患者临床心血管预后的预测价值.方法 选择103例MHD患者,均于当周第2次透析后,行44h动态血压监测,计算出标准差（standard deviation,8D）、变异系数（coefficient of variation,CV）和ARV.随访2年,收集患者预后资料,对相应的指标进行统计分析. 结果 Kaplan-Meier分析表明,根据44h收缩压（systolic blood pressure,SBP）标准差（44h-SBPSD）和44h收缩压变异系数（44h-SBPCV）均数进行分组,生存曲线分布无统计学意义（44h-SB-PSD：Log Rank x2=0.210,P=0.647;44h-SBPCV：Log Rank x2=2.738,P=0.098）;而根据44h-SBP ARV均数进行分组,高44h-SBP ARV组生存率明显低于低44h-SBP ARV组（77.8％比98.0％,Log Rank x2=9.645,P=0.002）.多因素Cox回归分析结果提示,44h-SBP ARV（HR1.132,95％ CI 0.912～1.312,p=0.017）及hs-CRP（HR 1.179,95％ CI 0.621～3.554,P=0.009）是MHD患者发生心血管死亡的独立危险因素.结论 MHD患者透析间期44h的ARV对心血管死亡有较高的预测价值,优于SD和CV.

Objective To evaluate the prognostic value of average real variability （ARV） of interdialyt- ic blood pressure for cardiovascular mortality in patients on maintenance hemodialysis （MHD）. Methods A total of 103 MHD patients were enrolled and 44-hour ambulatory blood pressure monitoring was carried out after the second hemodialysis session in a week. Standard deviation （SD）, coefficient of variation （CV）, and ARV of the interdialytic ambulatory systolic blood pressure in the 44-hour period （44h-SBP） was calculated. Patients were followed up for two years and the relevant indexes were analyzed. Results Kaplan-Meier analysis demonstrated that the survival curves were not significantly different between groups divided by means of the averaged SD （P=0.647） or CV （P=0.098） of 44h-SBR However, the survival rate was significantly lower in the group with higher ARV of 44h-SBP than in that with lower ARV of 44h-SBP （77.8% vs. 98.0%, P=-0.002）. Multivariate Cox regression demonstrated that ARV of 44h-SBP （HR=1. 132, P=-0.017） and hs-CRP （HR=1.179, P=-0.009） were the independent risk factors for cardiovascular death. Conclusions The ARV of 44h-SBP had a higher prognostic value for cardiovascular death, superior to the averaged SD or CV of 44h-SBP.