维持性血液透析患者透析中低血压与人体成分的关系

Association of Intradialytic Hypotension and Body Composition in Maintenance Hemodialysis Patients

目的:了解维持性血液透析患者透析中低血压(Intradialytic Hypotension,IDH)的发生率,并分析人体成分参数中影响IDH发生的因素。方法:采用观察性研究,于2019年6月起共纳入106例在南京医科大学第二附属医院血液净化中心行维持性血液透析的患者,透析结束后30 min以生物电阻抗的方法进行人体成分测量,并记录患者最近一个月有无发生IDH。采用单因素分析及多因素logistics回归分析影响IDH发生的人体成分因素。结果:(1)纳入研究的106名维持性血液透析患者中,总计21名患者一月内发生过IDH(19.8%);(2)单因素分析:IDH组与非IDH组间年龄、透析龄、PTH、ECW、ECW/TBW具有统计学差异(P<0.05);(3)多因素logistics回归分析:校正了性别、年龄、透析龄、PTH、是否合并糖尿病或心血管疾病、腰围等因素后,内脏脂肪(VAT)是IDH的独立危险因素(OR 4.658,95%CI1.360-15.954)。结论:IDH是血液透析患者最常见的并发症之一,在临床治疗中需予以高度重视。在人体成分各项参数中,内脏脂肪(VAT)是影响IDH发生的危险因素,我们可以针对VAT进行干预,继而减少IDH的发生率。

Objective:This study aimed to investigate the incidence of IDH,and to analyze the influencing factors of IDH among the body compositions.Methods:In this observational study,106 patients,who were received maintenance hemodialysis in the Second Affiliated Hospital of Nanjing Medical University since June 2019,were selected.The body composition was measured by using a bioelectrical impedance method 30 minutes after a hemodialysis episode.The IDH incidence in the past month before body composition measurement was recorded.Univariate analysis and multivariate Logistic regression analysis were used to analyze the factors that influenced the incidence of IDH among the body compositions.Results:(1)21 patients were diagnosed as IDH(19.8%);(2)The difference in age,HD vintage,PTH,ECW and ECW/TBW was statistically significant(P<0.05);(3)In multivariate Logistics regression models,VAT was the independent risk factor of IDH adjusted for gender,age,HD vintage,PTH,diabetes,cardiovascular diseases and waist.Conclusion:IDH is one of the most common complications in hemodialysis patients,which should be taken seriously in clinical practices.Among several available body compositions,the VAT was risk factors that affect the occurrence in maintenance hemodialysis patients.VAT can be intervened to reduce the incidence of IDH.