维持性血液透析患者血压与人体成分分析的相关性研究

The correlation between blood pressure and results of body composition monitor in maintenance hemodialysis patients

目的研究人体成分监测仪(body composition monitor,BCM)对维持性血液透析(maintenance hemodialysis,MHD)患者血压变化评估的意义。方法选择上海交通大学医学院附属仁济医院MHD患者126例,利用BCM进行人体成分分析。记录测得的透析前水负荷(over hydration,OH),记录患者预计超滤量、实际透析超滤量、透析时血压变化情况及透析间期血压情况。结果 (1)低血压发生组的透析前OH值低于无低血压发生组(2.13±1.22比1.48±1.26,P=0.017),同时低血压发生组的透析前OH值与预计超滤量的差值低于无低血压发生组(-1.18±1.19比-2.10±1.23,P=0.001)。(2)透析间期平均动脉压(mean artery pressure,MAP)与透析前OH值存在显著的正相关(r=0.301,P=0.003),透析前OH值与实际超滤量的差值与平均MAP同样呈现线性正相关(r=0.227,P=0.028)。(3)透析前OH值与实际超滤量值的差值预测MHD患者透析间期发生高血压ROC曲线下面积为0.681(0.586~0.776),P=0.001。(4)透析前OH值与预计超滤量的差值预测MHD患者透析中发生低血压的ROC曲线下面积为0.721(0.607~0.835),P=0.001。结论 BCM测得的透析前OH值与预计和实际的超滤量的差值能较好的预测透析间期MHD患者高血压以及透析中发生低血压的风险。

Object To study the significance of body composition monitor（BCM） for the assessment of blood pressure changes in maintenance hemodialysis（MHD） patients. Methods A total of 126 MHD patients and treated in Renji Hospital Shanghai Jiaotong University School of Medicine and analyzed by BCM were recruited. The values of pre-dialytic overhydration（OH）, expected ultrafiltration volume, actual ultrafiltration volume, intradialytic blood pressure change, and interdialytic blood pressure were recorded. Results（1）The pre-dialytic OH value was lower in hypotension group than in non-hypotension group（1.48±1.26 vs. 2.13±1.22, P=0.017）. The difference between pre-dialytic OH and expected ultrafiltration volume was lower in hypotension group than in non-hypotension group（-2.10 ± 1.23 vs.-1.18 ± 1.19, P=0.001）.（2） The interdialytic mean artery pressure（MAP） was positively correlated with the pre-dialytic OH value（r=0.301, P=0.003）, and was also positively correlated with the difference between pre-dialytic OH value and actual ultrafiltration volume（r=0.227, P=0.028）.（3）When the difference between pre-dialytic OH value and actual ultrafiltration volume was used to predict the interdialysis hypertension in MHD patients, the area under the ROC curve was0.681（0.586~0.776, P=0.001）.（4） When the difference between pre-dialytic OH value and expected ultrafiltration volume was used to predict the intradialytic hypotension in MHD patients, the area under the ROC curve was 0.721（0.607~0.835, P=0.001）. Conclusion The difference between pre-dialytic OH value from BCM and the actual ultrafiltration volume can be used to predict the risk of interdialysis hypertension; the difference between pre-dialytic OH value from BCM and the expected ultrafiltration volume can be used to predict the risk of intradialysis hypotension in MHD patients.