【摘要】目的建立本地区健康人群水负荷(overhydration,OH)回归公式，据此公式滴定维持性血液透析(maintenance hemodialysis, MHD)患者目标体质量，观察24h 动态血压(ambulatory blood pressure monitor,ABPM)变化及不良事件发生率。方法第一阶段为观察性研究：入选包头市中心医院314 名健康体检者，应用身体成分分析仪测量OH 等身体成分，通过多重线性回归分析得到计算OH 回归公式。第二阶段为干预性研究：入选MHD 患者存在高水负荷且24h ABPM 均值≥130/80mmHg，应用OH回归公式进行滴定目标体质量。结果健康人群得到OH的回归公式为：OH=6.203-0.019×Y-0.083×G-0.006×F+0.098×L-1.437×P(F =189.896,R2 =0.755, P＜0.001)，[Y：年龄；G：性别；F：脂肪含量(kg)；L：肌肉含量(kg)；P：相位角(°)]。入选8 名MHD 患者每周调节干体质量0.5～1.0kg，调节后75%患者达到目标体质量。调节后24h ABPM 监测收缩压≥180mmHg 数据比例较调节前显著下降(t=4.831, P= 0.002)，收缩压≤159mmHg(1mmHg=0.133kPa)的比例较调节前上升(t=-6.207,P=0.001)。结论由健康人群所得OH 计算公式支持个体化管理MHD患者体质量。
【Abstract】Objective We first established a formula for calculating overhydration (OH) in healthy population in the local region, and then used this formula to titrate the target dry body weight and to observe the 24-hour ambulatory blood pressure monitoring (ABPM) changes and the incidence of adverse events in maintenance hemodialysis (MHD) patients. Methods The first stage of the study was an observational study, which enrolled 314 healthy people after physical examinations at Baotou Central Hospital. Body composition monitor (BCM) was used to measure their volume load status and body composition. The OH-related multiple regression formula was obtained by multivariate linear regression analysis. The second stage was an intervention study, which enrolled MHD patients with OH and mean 24-hour ABPM ≥130/80 mmHg. The OH-related regression formula was applied to titrate the target dry weight. Results The multivariate linear regression formula for OH in healthy people is OH=6.203-0.019× Y-0.083×G-0.006×F+0.098×L-1.437×P (F=189.896, R2=0.755, P＜0.001; Y: age; G: sex; F: lipid ass; L: lean tissue mass; P: phase angle). Eight MHD patients were enrolled in the study. After adjustment, 75% of the patients had a dry weight compliant with the target value. The 24-hour ABPM showed that the proportion of systolic blood pressure≥180mmHg decreased from
30.188 ± 15.957% to 4.088 ± 2.719% (t=4.831, P=0.002), and the proportion of systolic blood pressure ≤ 159mmHg increased from 28.713±24.672% to 71.688±16.545% (t=-6.207, P= 0.001). Conclusion The OHrelated calculation formula obtained from healthy population can be used for dry body weight management individually in MHD patients.
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