应用生物电阻抗法评估维持性血液透析患者的容量状态与左心室肥厚及腹主动脉粥样硬化的关系

Assessment of the Relationship Between Volume Status and Left Ventricular Hypertrophy and Abdominal Aortic Atherosclerosis in Maintenance Hemodialysis Patients by Bioelectrical Impedance Analysis

目的:应用生物电阻抗法分析维持性血液透析患者(maintenance hemodialysis,MHD)体内容量状态及与左心室肥厚、腹主动脉粥样硬化的关系。方法:选择上海市浦东新区人民医院MHD患者92例及健康对照组24例,应用生物电阻抗分析仪器测量实验组及对照组透析前身体骨矿物质含量,基础代谢率,计算患者体质量指数(boay mass index,BMI)、ECW/TBW,同时检验实验组血红蛋白(hemoglobin,Hb),前白蛋白(prealbumin,PA),白蛋白(albumin,alb),钙(calcium,Ca),磷(phosphorus,P),超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP),计算钙磷乘积(Ca×P),根据心脏彩超结果判断实验组是否有左心室肥厚,根据腹主动脉超声结果判断实验组是否有腹主动脉粥样硬化。对实验组和对照组容量情况进行统计对比,以ECW/TBW为容量指标,分析该指标与其他检测指标的相关性。结果:(1)实验组92例MHD患者中有原发病慢性肾小球肾炎14例,高血压肾损害16例,糖尿病肾病48例,Ig A肾病4例,尿酸性肾病2例,淀粉样肾损害2例,多囊肾4例,不明原因2例。经统计分析,实验组和对照组年龄、性别、ICW、ECW、TBW、BMI、骨矿物质含量、基础代谢率差异无统计学意义,对照组ECW/TBW水平明显低于实验组,差异有统计学意义(P<0.05)。(2)ECW/TBW与Hb、PA、alb、Ca之间存在明显负相关,与hs-CRP、P之间存在明显正相关。(3)存在左心室肥厚的患者ECW/TBW高于非左心室肥厚患者,且ECW/TBW每增加一个单位,患者发生左心室肥厚的风险是原来的5.363倍。(4)腹主动脉粥样硬化患者的ECW/TBW高于非腹主动脉粥样硬化患者,且ECW/TBW每增加一个单位,患者发生腹主动脉硬化的风险是原来的2.902倍。结论:容量超负荷在维持性血液透析患者中普遍存在,且为血液透析患者左心室肥厚及腹主动脉粥样硬化的危险因素;容量负荷过重的患者营养状况更差,且可能存在微炎症状态。

Objective:Bioelectrical impedance spectroscopy was used to analyze the volume status of maintenance hemodialysis(MHD)patients and its relationship with left ventricular hypertrophy and abdominal aortic atherosclerosis.Methods:Total body water(TBW),extracellular water(ECW),intracellular water(ICW),bone mineral content,basal metabolic rate and body mass index(BMI)were measured before dialysis in 92 MHD patients and 24 healthy controls in Shanghai Pudong New Area People’s Hospital.BMI,ECW/TBW,hemoglobin(Hb),prealbumin(PA),albumin(alb),calcium(Ca),phosphorus(P),high sensitivity C-reactive protein(hs-CRP),calcium-phosphorus product(Ca×P)were also tested in the experimental group.The left ventricular hypertrophy(LVH)and abdominal aorta atherosclerosis were determined by color doppler ultrasound.Statistical comparison was made between the experimental group and the control group.ECW/TBW was used as the capacity index to analyze the correlation between the index and other detection indicators.Results:(1)In the experimental group,there were 14 cases of chronic glomerulonephritis,16 cases of hypertensive renal damage,48 cases of diabetic nephropathy,4 cases of Ig A nephropathy,2 cases of uric acid nephropathy,2 cases of amyloid nephropathy,4 cases of polycystic kidney and 2 cases of unknown causes.Statistical analysis showed that there was no significant difference in age,sex,ICW,ECW,TBW,BMI,bone mineral content and basal metabolic rate between the experimental group and the control group.The level of ECW/TBW in the control group was significantly lower than that in the experimental group(P<0.05).(2)ECW/TBW was negatively correlated with hemoglobin,prealbumin,albumin and calcium,and positively correlated with hypersensitive CRP and phosphorus.(3)The ECW/TBW of patients with left ventricular hypertrophy is higher than that of patients without left ventricular hypertrophy,and the risk of left ventricular hypertrophy is 5.363 times as high as that of patients with one unit increase of ECW/TBW.(4)The ECW/TBW of patients with abdominal aortic atherosclerosis is higher than that of non-abdominal aortic atherosclerosis patients,and the risk of abdominal aortic atherosclerosis is 2.902 times as high as that of non-abdominal aortic atherosclerosis patients when ECW/TBW is increased by one unit.Conclusion:Volume overload is common in maintenance hemodialysis patients;Volume overload is a risk factor for left ventricular hypertrophy and abdominal aortic atherosclerosis in hemodialysis patients;Patients with volume overload have worse nutritional status and may have microinflammation.