维持性血液透析患者高频透析相关低血压与透析后乳酸水平相关性研究

祖源; 喻倩; 李寒; 王世相

doi:10.3969/j.issn.1671-4091.2019.10.003

中国血液净化 >

2019 , Vol. 18 >Issue 10: 669 - 672

DOI: https://doi.org/10.3969/j.issn.1671-4091.2019.10.003

临床研究

维持性血液透析患者高频透析相关低血压与透析后乳酸水平相关性研究

祖源 ,
喻倩 ,
李寒 ,
王世相

展开

1. 首都医科大学附属北京朝阳医院血液净化科

收稿日期: 2019-02-28

修回日期: 2019-07-29

网络出版日期: 2019-09-27

收起

he relationship between high frequency dialysis related intradialytic hypotension and post-dialysis lactic acid level in maintenance hemodialysis patients#br#

ZU Yuan ,
YU Qian ,
LI Han ,
WANG Shi-Xiang

Expand

1Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China

Received date: 2019-02-28

Revised date: 2019-07-29

Online published: 2019-09-27

Fold

摘要

【摘要】目的研究维持性血液透析患者高频透析相关低血压(intradialytic hypotension,IDH)与透析后乳酸水平之间的关系。方法选取2018 年1~12 月间在首都医科大学附属北京朝阳医院血液净化科115 例规律维持性血液透析患者为研究对象，根据是否发生高频IDH(3 个月透析中IDH 发生频率≥30%)分为观察组和对照组。记录患者的一般资料和实验室资料，采取独立样本t 检验探讨观察组与对照组患者透析前透析后血气分析和透析前血常规、肾功能、离子、尿酸、血糖、C 反应蛋白等之间的关系。采用二元Logistic 回归分析高频IDH 的重要影响因素。绘制受试者工作特征曲线，评价透析后乳酸对高频IDH 的诊断价值。P＜0.05 为差异具有统计学意义。结果高频IDH 的患者占23.48%(27/115)。观察组患者红细胞平均血红蛋白浓度较对照组低[(321.670 ± 10.144)g/L 比(328.659±10.974)g/L, t=-2.944, P=0.004], 红细胞分布宽度- CV 升高(14.496%±1.535% 比13.686%±0.945%, t=2.594, P=0.014), 透析后血气分析乳酸升高[(1.881±0.627)mmol/L 比(1.437±0.700)mmol/L, t=2.949, P=0.004]，差异具有统计学意义。Logistic 回归分析显示红细胞分布宽度-CV升高和透析后乳酸升高是透析高频IHD 发生的危险因素(OR=1.630, 95% CI 1.046～2.539, P=0.031；OR=2.364, 95% CI1.237～4.517, P=0.009)。ROC 曲线显示，透析后乳酸曲线下面积AUC=0.721, 95% CI 0.605～0.837, P=0.001。结论透析后乳酸升高是高频IDH 的危险因素，具有一定的预测价值。

关键词： 肾透析; 低血压; 乳酸

本文引用格式

祖源 , 喻倩 , 李寒 , 王世相 . 维持性血液透析患者高频透析相关低血压与透析后乳酸水平相关性研究[J]. 中国血液净化, 2019 , 18(10) : 669 -672 . DOI: 10.3969/j.issn.1671-4091.2019.10.003

Abstract

【Abstract】Objective To study the relationship between high frequency dialysis related intradialytic hypotension (IDH) and post-dialysis lactic acid level in maintenance hemodialysis (MHD) patients. Methods A total of 115 patients with regular MHD were enrolled in this study. These patients were treated in the Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University during the period from January 1st, 2018 to January 1st, 2019. According to the prevalence of high frequency dialysis related IDH in the 3 months of dialysis period, they were divided into observation group (the prevalence ≥30%) and control group (the prevalence <30%). Their clinical and laboratory data were recorded. Independent sample t test was used to investigate the relationships between the blood gas changes before and after dialysis and the pre- dialytic blood routine, renal function, ions, uric acid, blood sugar and C-reactive protein in observation group and control group. Binary logistic regression was used to analyze the important factors influencing the high frequency dialysis related IDH. Receiver operating characteristic (ROC) curve was used to evaluate the value of lactic acid for the diagnosis of high frequency dialysis related IDH. P＜0.05 was considered to be statistically significant. Results Patients with high- frequency dialysis related IDH accounted for 23.48% (27/115) of the patients. Compared with those in control group, mean hemoglobin concentration of red blood cells was lower (321.670±10.144g/L vs. 328.659±10.974g/L, t=-2.944, P=0.004), red blood cell distribution width

(RDW-CV) was higher (14.496±1.535% vs. 13.686±0.945%, t=2.594, P=0.014), and post-dialysis lactic acid was higher (1.881±0.627mmol/L vs. 1.437±0.7mmol/L, t=2.949, P=0.004) in observation group. Binary logistic regression showed that the higher levels of red blood cell distribution width and post- dialysis lactic acid were the risk factors for high- frequency dialysis related IDH (OR=1.630, 95% CI 1.046～2.539, P=0.031; OR=2.364, 95% CI 1.237～4.517, P=0.009). ROC curve demonstrated that the area under the curve (AUC) of lactic acid was 0.721 (95% CI 0.605～0.837, P=0.001). Conclusions The increase of post-dialysis lactic acid is an important risk factor for high frequency dialysis related IDH and is valuable for the prediction of the IDH.

Key words： Renal dialysis; Hypotension; Lactic acid

参考文献

参考文献
[1] Mmer BF，Henrieh WL．Recent advances in the prevention and management of intradiMytic hypotension[J]．J Am SOcNephrol，2008，19(1)：8-11．DOI:10．1681/ASN．2007091006.
[2] Jeffrey A. and Nicolaos E. Lactic Acidosis [J].N Engl J Med 2014; 371(24):2309-2319. DOI:10.1056/NEJMra1309483.
[3] 汪知玉, 陈孜瑾, 蒋钻红，等.血液透析患者透析中低血压的发生情况及其与预后的关系[J].中华肾脏病，2017，33（7）：495-503. DOI:0.3760/cma.j.issn.1001-7097.2017.07.003.
[4] Chang TI，Paik J，Greene T，et a1．Intradialytie hypotension and vascular access thrombosis[J]．J Am Soc Nephrol，201l，22 (8)：1526-1533．DOI：10．1681，ASN．2010101 119．
[5] Stef6nsson BV，Brunelli SM，Cabrera C，et a1．Intradialytie hypotension and risk of cardiovascular disease[J]．Clin J Am Soc Nephrol，2014，9(12)：2124·2132．DOI:10．2215/CJN．026803 14.
[6] 余金波，邹建洲，刘中华，等．维持性血液透析患者透析中低血压的危险因素研究[J].中国血液净化，2012，1l(4)：189-193．DOI:10．3969／i．issn．1671--4091．2012．04．004．
[7] Shoji T，Tsubakilmm Y Fujii M，et a1．Hemedialysis--associated hypotension as an independent risk factor form two-ear mortality in hemodialysis patients[J]．Kidney Int，2004，66(3)：1212-1220．DOI:10.1111/j.1523-1755.2004.00812x.
[8] Coresh J，Selvin E，Stevens LA，et a1．Prevalence of chronic kidney disease in the United States[J]．JAMA，2007，298：2038-2047．DOI:10.1001/jama.298.17.2038.
[9] Wen CP, Cheng TY,T sai MK，et a1．All-cause mortality attributable to chronic kidney disease：a prospective cohort study based on 462293 adults in Taiwan[J]．Lancet，2008，371：2173-2182．DOI: 10.1016/S0140-6736(08)60952-6.
[10] Tisler A，Akocsi K，Harshegyi I，et a1．Comparison of dialysis and clinical characteristics of patients with frequent and occasional hemodialysis-associated Hypotension[J]．Kidney Blood Press Res，2002，25：97-102．DOI:10.1159/000063515.
[11]Buys S，and Craven C. MCHC in intravascular hemolysis[J]. American journal of hematology,1990,33(4):282-283. DOI:10.1002/ajh.2830330415.
[12] Salvagno GL，Sanchis-Gomar F，Picanza A，et a1．Red blood cell distribution width：A simple parameter with multiple clinical applications[J]．Crit Roy Cl in Lab Sci，2015，52(2)：86-105．DOI： 10.3109/10408363.2014.992064.
[13]朱润章，高占辉，王笑云，等.红细胞分布宽度与血液透析低血压相关性探索[J].中国血液净化，2018，17（11）：739-742. DOI: 10．3969／j．i ssn．1671-4091．2018．11．005.
[14]Akker J，Nijsten MW，Jansen TC．Clinical use of lactate monitoring in critically ill patients[J]．Ann Intensive Care，2013，3(1)：12．DOI:10.1186/2110-5820-3-12.
[15]Billeter A, Turina M, Seifert B, et al. Early serum procalcitonin, interleukin-6, and 24-hour lactate clearance: useful indicators of septic infections in severely traumatized patients [J]. World JSurg, 2009, 33 (3): 558-566. DOI:10.1007/s00268-008-9896-y.
[16] Jones AE，Shapiro NI，Trzeciak S，et a1．Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy：a randomized clinical trial[J]. JAMA,2010,303(8):739-746. DOI:10.1001/jama.2010.158.
[17] 庄冰，宋宗纬，骆静，等. 维持性血液透析患者的透后疲乏及相关因素分析[J].中华肾脏病，2018，34（4）：249-254. DOI：10．3760／cma．j．issn．1001—7097．2018．04．002.

Options

文章导航

模态框（Modal）标题

摘要

本文引用格式

Abstract

参考文献