维持性血液透析病人干体重预测方程的构建和验证

Construction and validation of prediction equations of dry weight in patients with maintenance hemodialysis

[目的]采用Basile的“四步法”构建基于生物电阻抗分析的维持性血液透析病人干体重预测方程,并对方程进行验证。[方法]便利抽取上海市某三级甲等医院的138例维持性血液透析病人作为血液透析组,选取上海市某三级甲等医院的816名体检者作为对照组,选取上海市其他两所医院的35例维持性血液透析病人作为验证组。对Basile的血液透析病人干体重预测方程构建方法进行调整,利用血液透析组、对照组、验证组人群数据构建并验证适用我国维持性血液透析病人的干体重预测方程。[结果]多元线性回归分析结果显示:397名正常体质指数(BMI)的男性体检者体重与其年龄、身高、50 kHz电阻值(R50)呈线性相关(R2=0.783,P<0.001),378名正常BMI的女性体检者体重与身高、R50呈线性相关(R2=0.662,P<0.001)。矫正后男性维持性血液透析病人干体重=(0.859427×身高-0.025143×年龄-0.034933×R50-59.867424)×透析后BMI/21.76;矫正后女性维持性血液透析病人干体重=(0.697978×身高-0.032994×R50-34.080396)×透析后BMI/20.44。经验证组病人数据验证,结果显示:验证组男性和女性干体重实际值和预测值比较,差异均无统计学意义(P>0.05)。[结论]构建的维持性血液透析病人干体重预测方程对病人干体重的预测值和实际值间有较好一致性,生物电阻抗分析法可以与临床上的其他方法结合起来更好地指导医护人员对病人进行容量管理。

Objective:To construct a prediction equation of dry weight in patients with maintenance hemodialysis based on bioelectrical impedance analysis by"four⁃step method"of Basile,and to verify the equation.Methods:A total of 138 maintenance hemodialysis patients from a tertiary A hospital in Shanghai was obtained as hemodialysis group by using convenience simpling.And 816 medical examiners from a tertiary A hospital in Shanghai was selected as control group.Then 35 maintenance hemodialysis patients from two another hospitals in Shanghai were selected as verification group.Adopting Basile'method,prediction equation of dry weight in patients with maintenance hemodialysis was constructed and adjusted.Data from hemodialysis group,control group,and verification group were used to construct and verify the prediction equation of dry weight Chinese in patients with maintenance hemodialysis.Results:Multiple linear regression analysis results showed that the weights of 397 male medical examiner with normal body mass index(BMI)presented linear correlation with their age,height,and resistance at 50 kHz(R50)(R2=0.783,P<0.001).The weights of 378 female medical examiner with normal BMI had linear correlation with their height and R50(R2=0.662,P<0.001).The equation of dry weight of male patients with maintenance hemodialysis after correction was(0.859427×height-0.025143×age-0.034933×R50-59.867424)×BMI after dialysis/21.76.The equation of dry weight of female patients with maintenance hemodialysis after correction was(0.697978×height-0.032994×R50-34.080396)×BMI after dialysis/20.44.Validated by data from patients in validation group,the results showed that there was no statistically significant difference between actual value and predicted value of dry weights in men and women in validation group(P>0.05).Conclusions:The constructed prediction equation of dry weight in patients with maintenance hemodialysis has a good consistency between predicted value and actual value of patient's dry weight.The bioelectrical impedance analysis method combined with other clinical methods would be better to guide medical staff to carry out capacity management among patients.