在线尿素清除率监测对血液透析充分性评估的研究

Clinical research of hemodialysis adequacy evaluation with Kt/V by on-line clearance monitoring and by blood sampling calculation

目的探讨在线尿素清除率监测(on-line clearance monitoring,OCM)对血液透析充分性的评估价值。方法选取规律血液透析患者135例,其中男性66例,女性69例,平均年龄(63.3±15.9)岁。利用OCM监测Kt/V值(Kt/Vocm值),同时透析前、后取全血检测尿素氮浓度,根据单室尿素动力模型DaugirdasⅡ公式计算Kt/V值(Kt/VD值),通过线性相关分析了解二者的相关性并通过多元线性回归分析得出影响Kt/Vocm值的相关临床因素。结果本组135例患者OCM法测得的Kt/V值与采血计算法所得的Kt/V值分别为(1.25±0.33)与(1.44±0.30),直线回归分析相关指数r=0.512,P<0.001。身高、体质量、透析血流量是Kt/Vocm值的独立影响因素,体质量、身高与之呈负相关[OR=-0.412,P<0.001,95%可信区间(-0.015,-0.006);OR=-0.240,P=0.01,95%可信区间(-0.015,-0.002)],透析血流量与之呈正相关[OR=0.349,P<0.001,95%可信区间(0.003,0.008)]。比较Kt/Vocm值达标组(Kt/Vocm值≥1.2)和不达标组(Kt/Vocm值<1.2)患者各项临床资料的差异,发现2组患者的性别、尿素下降率(urea reduction ratio,URR)、体质量、空腹血糖、体表面积、透析血流量存在显著差异。结论 OCM监测Kt/V值与采血计算Kt/V值有显著相关性,Kt/Vocm值低于Kt/VD值,身高、体质量和透析血流量是其独立影响因素。OCM能够很好的反映患者单次透析的尿素清除,可以作为临床评价透析充分性的简便、可靠指标。

Objective To evaluate the value of on-line clearance monitoring（ OCM） in hemodialysis adequacy evaluation. Methods 135 maintenance hemodialysis patients were investigated by using OCM appliance,including 66 males and 69 females,with the mean SD age of（ 63. 3 ± 15. 9） years old. Meanwhile,blood urea nitrogen（ BUN） in pre-and post-dialysis periods was examined to calculate Kt/V based on the equation of Daugirdas Ⅱ. We then evaluated the correlation between the two methods,and analyzed the clinical factors influencing the OCM. Results Kt/V value by OCM（ Kt/Vocm） and by calculation（ Kt/VD） was（ 1. 25 ± 0. 33） and（ 1. 44 ± 0. 30）,respectively,and the correlation coefficient was 0. 512（ P〈0. 001）. Height,body weight and blood flow were independent factors of Kt/Vocm. Body weight and height were negatively correlated with Kt/Vocm [OR =-0. 412（ P〈0. 001）,95% CI（-0. 015,-0. 006）; OR =-0. 240（ P = 0. 01）,95% CI（-0. 015,-0. 002）,respectively],while blood flow was positively correlated with Kt/Vocm [OR = 0. 349（ P〈0. 001）,95% CI（ 0. 003,0. 008） ]. According to whether Kt/Vocm was more than 1. 2,the patients were divided into two groups,and the differences in clinical data between them were compared. The sex,urea reduction ratio（ URR）,body weight,fasting blood glucose,body surface area,and hemodialysis blood flow were significantly different between the two groups.Conclusions Kt/Vocm is significantly related with that by calculation. Kt/Vocm is lower than that by calculation,which is affected by height,body weight and blood flow. Therefore,OCM can reflect the ureaclearance of patients on single dialysis,and can be used as a simple and reliable indicator of clinical adequacy of hemodialysis.