维持性血液透析患者的容量负荷分布及其与血压关系的多中心研究

张周沧; 甘良英; 李忠心; 马迎春; 秦燕; 康志敏; 齐桂静; 朱丽; 杨帆; 王欣欣; 薛宇; 房艳辉; 郭兴斌; 杨清华; 苏香彪; 张东亮; 王梅

doi:10.3969/j.issn.1671-4091.2020.03.008

中国血液净化 >

2020 , Vol. 19 >Issue 03: 174 - 178

DOI: https://doi.org/10.3969/j.issn.1671-4091.2020.03.008

临床研究

维持性血液透析患者的容量负荷分布及其与血压关系的多中心研究

张周沧 ,
甘良英 ,
李忠心 ,
马迎春 ,
秦燕 ,
康志敏 ,
齐桂静 ,
朱丽 ,
杨帆 ,
王欣欣 ,
薛宇 ,
房艳辉 ,
郭兴斌 ,
杨清华 ,
苏香彪 ,
张东亮 ,
王梅

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1北京大学国际医院肾内科部血液净化中心
2北京大学人民医院肾内科
3首都医科大学附属北京潞河医院肾病中心
4首都医科大学康复医学院中国康复研究中心北京博爱医院肾内科
5北京老年医院肾内科
6北京航空总医院肾内科
7北京市昌平区医院肾内科

收稿日期: 2020-01-06

修回日期: 2020-01-15

网络出版日期: 2020-03-12

基金资助

北京大学国际医院院内科研基金(YN2017QN15)

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A multicenter study of the relationship between fluid status assessed by bioimpedance analysis and blood pressure in maintenance hemodialysis patients#br#

ZHANG Zhou-Cang ,
GAN Liang-Ying ,
LI Zhong-Xin ,
MA Ying-Chun ,
QIN Yan ,
KANG Zhi-Min ,
QI Gui-Jing ,
ZHU Li ,
YANG Fan ,
WANG Xin-Xin ,
XUE Yu ,
FANG Yan-Hui ,
GUO Xing-Bin ,
YANG Qing-Hua ,
SU Xiang-Biao ,
ZHANG Dong-Liang ,
WANG Mei

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1 Blood Purification Center, Department of Nephrology, Peking University International Hospital, Beijing 102206, China; 2 Department of Nephrology, Peking University People’s Hospital, Beijing 100044, China; 3 Central for Kidney Disease, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China;
4 Department of Nephrology, Beijing Bo’ai Hospital, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, China; 5 Department of Nephrology, Beijing Geriatric Hospital, Beijing 100095, China; 6 Department of Nephrology, Aviation General Hospital, Beijing 100012, China; 7 Department of Nephrology, Beijing Changping Hospital, Beijing 102200, China

Received date: 2020-01-06

Revised date: 2020-01-15

Online published: 2020-03-12

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摘要

【摘要】目的利用生物电阻抗分析(bioimpedance analysis，BIA)测量容量负荷，同期测量居家血压(home blood pressure，HBP)，探讨维持性血液透析(maintenance hemodialysis，MHD)患者容量负荷分布情况及其与血压的关系。方法北京市7 个血液净化中心MHD 的患者共113 人，BIA 测患者的多余水分(overhydration，OH)，计算每周的时间平均容量负荷(weekly time-averaged overhdration，wTAOH)，依据wTAOH 分4 组，容量不足组(组1，wTAOH＜-0.25L)、容量负荷正常组(2，-0.25L≤wTAOH≤1.25L)、容量超负荷组(组3，1.25L＜wTAOH≤2.8L)、容量严重超负荷组(组4，wTAOH＞2.8L)，比较4 组居家收缩压(home systolic blood pressure，HSBP)及相关指标差异；当周测量HBP 并依据135≥HSBP≥160mmHg 对患者血压分级：1 级(HSBP＜135mmHg)、2 级(135mmHg≤HSBP＜160mmHg)、3 级(HSBP≥160mmHg)；对wTAOH 与HSBP 进行Pearson 相关分析。结果MHD 患者中，组3 占28.3%，组4 占18.6%，组2 占40.7%，组1 占12%；HSBP2 级和3 级占70%，其中3 级占28.4%，1 级占30%；将wTAOH 与HSBP 进行Pearson 相关分析，结果显示两者存在正相关(r=0.200，P =0.033)；组4 的HSBP 高于组2 和组3(t 值分别为2.773，2.051；P 值分别为0.007，0.043)，但与组1 无显著差异。结论容量超负荷在MHD 患者中仍普遍存在；血压虽然与容量负荷相关，但不能准确反映MHD 患者的容量负荷，尤其是在容量不足和正常的时候。

关键词： 生物电阻抗分析; 居家血压; 容量负荷; 维持性血液透析; 多中心

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张周沧 , 甘良英 , 李忠心 , 马迎春 , 秦燕 , 康志敏 , 齐桂静 , 朱丽 , 杨帆 , 王欣欣 , 薛宇 , 房艳辉 , 郭兴斌 , 杨清华 , 苏香彪 , 张东亮 , 王梅 . 维持性血液透析患者的容量负荷分布及其与血压关系的多中心研究[J]. 中国血液净化, 2020 , 19(03) : 174 -178 . DOI: 10.3969/j.issn.1671-4091.2020.03.008

Abstract

【Abstract】Objective Bioimpedance analysis (BIA) was used to evaluate volume load and the blood pressure (BP) at home was measured at the same time to study the relationship between fluid status and BP in maintenance hemodialysis (MHD) patients. Methods A total of 113 MHD patients in the 7 blood purification centers in Beijing were enrolled in this study. BIA was used to measure the overhydration (OH) status and to calculate the weekly timEaveraged overhydration (wTAOH). The patients were then assigned into 4 groups: the dehydration group (group 1, wTAOH less than - 0.25L), the normohydration group (group 2, ≤- 0.25L

wTAOH ≤1.25L), the overhydration group (group 3, <1.25L wTAOH ≤2.8L), and severe overhydration group (group 4, wTAOH >2.8L). The home systolic blood pressure (HSBP) and the related parameters were compared among the 4 groups. The patients were divided into 3 categories based on the HSBP in a week: class 1 (HSBP <135mmHg), class 2 (≤135mmHg HSBP <160mmHg) and class 3 (HSBP≥160mmHg). Pearson correlation analysis was used to investigate the relationship between wTAOH and HSBP. Results BIA found that the rates of MHD patients with overhydration (group 3) and severe overhydration (group 4) were 28.3% and 18.6%, respectively; the rates of the patients with normohydration (group 2) and dehydration (group 1) were 40.7% and 12%, respectively. The MHD patients in class 1(HSBP <135mmHg), class 2 (≤ 135mmHg HSBP <160mmHg) and class 3 (HSBP >160mmHg) were 30.0%, 41.6% and 28.4%, respectively. Pearson correlation revealed that wTAOH was positively correlated with HSBP (r=0.200, P=0.033). The HSBP was higher in group 4 than in groups 2 and 3 (156.0±16.9 vs. 143.0±17.5mmHg, t=2.773, P=0.007 for group 4 vs. group 2; 156.0±16.9 vs. 145.7±18.5mmHg, t=2.051, P=0.043 for group 4 vs. group 3) but had no statistical significance between groups 4 and 1. Conclusion Overhydration is prevalent in MHD patients. BP is positively correlated with overhydration. However, BP cannot accurately reflect volume load status, especially the normohydration and dehydration status, in MHD patients.

Key words： Bioimpedance analysis; Home blood pressure; Overhydration; Maintenance hemodialysis; Multicenter

参考文献

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