使用艾考糊精腹透液的自动腹膜透析患者发生高血压的相关因素分析

Analysis of hypertension related factors in patients with automatic peritoneal dialysis using acodextrinperitoneal dialysis solution

目的探究使用艾考糊精腹透液的自动腹膜透析(APD)患者发生高血压的相关影响因素。方法回顾性分析2019年1月至2019年10月在本院接受APD治疗的138例患者的临床资料,行腹膜平衡试验以划分不同转运状态,其中低转运组4例、低平均转运组33例、高平均转运组64例和高转运组37例。采用标准方法从24h尿液和腹膜透析液样本中计算自动腹膜透析充足率和膳食蛋白氮显现率。检测患者血中氨基末端脑钠肽前体(NT-proBNP)的含量,并测量尿液和透析液中的钠。采用COX回归分析与高血压相关的危险因素。结果与低转运组患者相比,高转运组患者的收缩压、NT-proBNP、细胞外液(ECW)以及ECW/身高都较高(均P<0.05)。单因素分析结果显示,血压与糖尿病、血清肌酐、尿钠、4 h透析液中肌酐与血肌酐比值、NT-proBNP、ECW/身高和骨骼肌质量(SMM)/身高平方呈正相关,与血清白蛋白呈负相关(均P<0.001)。左心室射血分数(LVEF)、左心室质量指数(LVMI)、收缩压和抗高血压药物的应用与血压无相关性(均P>0.05)。多因素回归分析显示,4h透析液中肌酐与血肌酐比值、尿钠和NT-proBNP是血压的独立危险因素(均P<0.001)。结论接受以艾考糊精为透析液的APD患者,高血压的发生与高转运状态、NT-proBNP和尿钠增多相关。腹膜透析患者应加强对血压的管理。

Objective To explore the related factors of hypertension in patients with automatic peritoneal dialysis using acodextrin peritoneal dialysis solution.MethodsThe clinical data of 138 patients who received automatic peritoneal dialysis in our hospital from January 2019 to October 2019 were retrospectively analyzed.Peritoneal balance test was performed to divide dfferent transport states,including 4 cases in the low transport group,33 cases in the low average transport group,64 cases in the high average transport group,and 37 cases in the high transport group.The adequacy rate of automatic peritoneal dialysis and the appearance rate of dietary protein nitrogen were calculated from 24-hour urine and peritoneal dialysis fluid samples.The content of amino-terminal brain natriuretic peptide precursor(NT-proBNP)in blood was detected,and the sodium in urine and dialysate was measured.COX regression analysis was used to analyze the risk factors associated with hypertension.Results Systolic blood pressure,NT-proBNP,ECW and ECW/height were higher in the high-transport group than in the low-transport group(all P<0.05).In unifactor analysis,blood pressure was positively correlated with diabetes mellitus,serum creatinine,urine sodium,creatinine to serum creatinine ratio in 4 h dialysate,NT-proBNP,ECW/height and SMM/height squared,and negatively correlated with serum albumin(all P<0.001).Left ventricular ejection fraction(LVEF),left ventricular mass index(LVMI),systolic blood pressure,and antihypertensive drug use were not correlated with blood pressure(all P>0.05).Multifactor regression analysis showed that creatinine to serum creatinine ratio in 4 h dialysate,urinary sodium and NT-proBNP were independent risk factors for blood pressure(all P<0.001).Conclusions In patients undergoing automatic peritoneal dialysis with acodextrin as dialysate,hypertension is associated with high transport status,NT-proBNP and increased urinary sodium.Peritoneal dialysis patients should limit sodium intake to strengthen the management of blood pressure.