维持性血液透析患者难治性高血压相关危险因素分析

Risk factors for treatment resistant hypertension in continuous hemodialysis patients

目的 :从普通血液和生化指标中寻找与维持性血液透析患者难治性高血压(treatment resistant hypertension,TRH)相关的危险因素,为透析患者的高血压治疗提供帮助。方法:2009年12月—2015年6月在南京医科大学第一附属医院行规律血液透析的高血压患者174例,其中病例组TRH患者69例,对照组非TRH患者105例。采用Logistic回归分析,寻找与TRH相关的危险因素。结果:两组患者性别、肌酐水平和透析时长上差异无统计学意义。病例组平均年龄、尿酸、血白细胞、天门冬氨酸氨基转移酶(aspertate aminotransferace,AST)、谷氨酰转肽酶(gamma-glutamyl transferase,GGT)和腺苷脱氨酶(adenosine deaminase,ADA)水平均显著低于对照组;而病例组血清钙和白蛋白(albumin,ALB)显著高于对照组。单因素Logistic回归显示:年龄<40岁(OR:3.350,P=0.010)、GGT<20 U/L(OR:2.554,P=0.024)、10 U/L≤AST<15 U/L(OR:2.499,P=0.011)、ADA<12 U/L(OR:2.259,P=0.044)是透析患者TRH的危险因素;ALB<41 g/L是保护因素(OR:0.298,P=0.002)。逐步法多因素Logistic回归分析显示:ALB水平与TRH呈正相关(OR:1.130,P=0.002),ADA水平与TRH呈负相关(OR:0.900,P=0.027)。结论:年龄<40岁、血清GGT<20 U/L、10≤AST<15 U/L和ADA<12 U/L是维持性血液透析患者TRH的危险因素,而血清ADA降低和血清ALB升高是TRH的独立危险因素。

Objective： To identify risk factors associated with treatment resistant hypertension （TRH） and easily detectable through routine blood tests in chronic kidney diseas e （CKD） patients,who received hemodialysis.Methods： One hundred and seventy-four CKD patients with hypertension receiving hemodialysis between December 2009 and June 2015 were enrolled in this study.Of these patients,69 patients had TRH; the other 105 patients had not.Univariate and multivariate logistic regression analysis was used to assess risk factors associated with TRH.Results： In our study population,the gender distribution,serum level of creatinine and hemodialysis duration were comparable between two groups.The mean age,serum leves of uric acid （UA）,white blood cell numbers,aspertate aminotransferase （AST）,gamma-glutamyl transferase （GGT） and adenosine deaminase （ADA） were lower in the case group than those in the control group.The serum level of calcium and albumin （ALB） was higher in the case group than that in the control group.Age younger than 40 （OR：3.350,P=0.010）,GGT less than 20 U/L （OR：2.554,P=0.024）,10≤AST15 U/L （OR：2.499,P=0.011）,and ADA less than 12 U/L （OR：2.259,P =0.044） were positively correlated with TRH.Meanwhile,serum level of ALB less than 41 g/L （OR：0.298,P=0.002） was negatively correlated with TRH.Stepwise multi-variate logistic regression showed that ALB was positively （OR：1.130,P=0.002） and ADA was negatively （OR：0.900,P=0.027） correlated with TRH.Conclusion： The younger age （40 years）and lower serum level of GGT （20 U/L）,AST （10 U/L≤AST15 U/L） and ADA （12 U/L） are risk factors,and serum levels of ADA decreasing and ALB increasing are independent risk factors for TRH in hemodialysis patients.