目的本文拟评估血压变异度指标--平均实际变异(average real variability，ARV)对判断维持性血液透析(maintenance hemodialysis,MHD)患者临床心血管预后的预测价值。方法选择103 例MHD 患者，均于当周第2 次透析后，行44h 动态血压监测，计算出标准差(standard deviation，SD)、变异系数(coefficient of variation，CV)和ARV。随访2 年，收集患者预后资料，对相应的指标进行统计分析。结果Kaplan-Meier 分析表明，根据44h 收缩压(systolic blood pressure，SBP)标准差
(44h-SBPSD)和44h 收缩压变异系数(44h-SBPCV)均数进行分组，生存曲线分布无统计学意义(44h-SBPSD：Log Rank χ2=0.210，P=0.647;44h-SBPCV：Log Rank χ2=2.738，P=0.098)；而根据44h-SBP ARV 均数进行分组，高44h-SBP ARV 组生存率明显低于低44h-SBP ARV 组(77.8% 比98.0%，Log Rank χ2=9.645, P=0.002)。多因素Cox 回归分析结果提示，44h-SBP ARV(HR 1.132，95% CI 0.912～1.312，P=0.017)及hs-CRP(HR 1.179，95% CI 0.621～3.554, P=0.009)是MHD 患者发生心血管死亡的独立危险因素。结论MHD 患者透析间期44h 的ARV 对心血管死亡有较高的预测价值，优于SD和CV。

Objective To evaluate the prognostic value of average real variability (ARV) of interdialytic blood pressure for cardiovascular mortality in patients on maintenance hemodialysis (MHD). Methods A total of 103 MHD patients were enrolled and 44-hour ambulatory blood pressure monitoring was carried out
after the second hemodialysis session in a week. Standard deviation (SD), coefficient of variation (CV), and ARV of the interdialytic ambulatory systolic blood pressure in the 44-hour period (44h-SBP) was calculated. Patients were followed up for two years and the relevant indexes were analyzed. Results Kaplan- Meier analysis demonstrated that the survival curves were not significantly different between groups divided by means of the averaged SD (P=0.647) or CV (P=0.098) of 44h-SBP. However, the survival rate was significantly lower in the group with higher ARV of 44h- SBP than in that with lower ARV of 44h- SBP (77.8% vs.98.0%, P=0.002). Multivariate Cox regression demonstrated that ARV of 44h-SBP (HR=1.132, P=0.017) and hs-CRP (HR=1.179, P=0.009) were the independent risk factors for cardiovascular death. Conclusions The ARV of 44h-SBP had a higher prognostic value for cardiovascular death, superior to the averaged SD or CV of 44h-SBP.