【摘要】目的研究人体成分监测仪(body composition monitor,BCM)对维持性血液透析(maintenance hemodialysis,MHD)患者血压变化评估的意义。方法选择上海交通大学医学院附属仁济医院 MHD 患者126 例，利用BCM 进行人体成分分析。记录测得的透析前水负荷(over hydration,OH)，记录患者预计超滤量、实际透析超滤量、透析时血压变化情况及透析间期血压情况。结果①低血压发生组的透析前OH 值低于无低血压发生组(2.13±1.22 比1.48±1.26，P=0.017)，同时低血压发生组的透析前OH 值与预计超滤量的差值低于无低血压发生组(-1.18±1.19 比-2.10±1.23，P=0.001)。②透析间期平均动脉压(mean artery pressure,MAP)与透析前OH 值存在显著的正相关(r=0.301，P=0.003)，透析前OH值与实际超滤量的差值与平均MAP 同样呈现线性正相关(r=0.227,P =0.028)。③透析前OH 值与实际超
滤量值的差值预测MHD 患者透析间期发生高血压ROC 曲线下面积为0.681(0.586～0.776)，P=0.001。④透析前OH 值与预计超滤量的差值预测MHD 患者透析中发生低血压的ROC 曲线下面积为0.721(0.607～0.835)，P=0.001。结论BCM 测得的透析前OH 值与预计和实际的超滤量的差值能较好的预测透析间期MHD 患者高血压以及透析中发生低血压的风险。

【Abstract】Object To study the significance of body composition monitor (BCM) for the assessment of blood pressure changes in maintenance hemodialysis (MHD) patients. Methods A total of 126 MHD patients and treated in Renji Hospital Shanghai Jiaotong University School of Medicine and analyzed by BCM were recruited. The values of pre- dialytic overhydration (OH), expected ultrafiltration volume, actual ultrafiltration volume, intradialytic blood pressure change, and interdialytic blood pressure were recorded. Results ①The pre-dialytic OH value was lower in hypotension group than in non-hypotension group (1.48±1.26 vs. 2.13±1.22, P=0.017). The difference between pre-dialytic OH and expected ultrafiltration volume was lower in hypotension
group than in non- hypotension group (-2.10±1.23 vs. -1.18±1.19, P=0.001). ②The interdialytic mean artery pressure (MAP) was positively correlated with the pre-dialytic OH value (r=0.301, P=0.003), and was also positively correlated with the difference between pre-dialytic OH value and actual ultrafiltration volume
(r=0.227, P=0.028). ③When the difference between pre-dialytic OH value and actual ultrafiltration volume was used to predict the interdialysis hypertension in MHD patients, the area under the ROC curve was 0.681 (0.586～0.776, P=0.001). ④ When the difference between pre-dialytic OH value and expected ultrafiltration volume was used to predict the intradialytic hypotension in MHD patients, the area under the ROC curve was 0.721 (0.607～0.835, P=0.001). Conclusion The difference between pre-dialytic OH value from BCM and the actual ultrafiltration volume can be used to predict the risk of interdialysis hypertension; the difference between pre-dialytic OH value from BCM and the expected ultrafiltration volume can be used to predict the risk of intradialysis hypotension in MHD patients.