【摘要】目的评估透析前血浆渗透压对血液透析(hemodialysis,HD)患者频发性透析中低血压(frequent-intradialytic hypotension,f-IDH)的预测价值。方法以2020 年6 月～2021 年5 月在浙江中医药大学附属杭州市中医院行HD 治疗并发f-IDH 的患者100 例为病例组，按性别、年龄、糖尿病频数匹配同期行HD 治疗但未并发f-IDH 的患者100 例为对照组。采用Logistic 回归分析f-IDH 的危险因素，以受试者工作特征(ROC)曲线下面积判断透析前血浆渗透压对f-IDH 的预测价值。结果病例组的甲状旁腺激素、三酰甘油、透析前血浆渗透压、平均超滤量/干体质量高于对照组(Z=-2.889, P=0.004；Z=-3.422, P=0.001；t=2.642, P=0.009；t=3.700, P＜0.001)，白蛋白低于对照组(t=2.402，P=0.018)；二元Logistic 回归分析显示透析前血浆渗透压升高(OR=1.255，95% CI：1.001～1.112，P=0.035)、白蛋白水平低(OR=0.847，95% CI：0.723～0.992，P=0.040)、平均超滤量/干体质量过大(OR=1.719,95% CI：
1.225～2.412，P=0.002)是HD 患者并发f-IDH 的独立危险因素。ROC 曲线分析显示透析前血浆渗透压诊断f-IDH 的AUC 为0.702，最佳临界值为304.65mOsm/(Kg·H2O)。结论透析前血浆渗透压升高是HD 患者并发f-IDH的独立危险因素，并对f-IDH 有一定预测价值。
【Abstract】Objective To evaluate the value of pre-dialysis plasma osmolality for the prediction of frequent-intradialytic hypotension (f-IDH) in hemodialysis (HD) patients. Methods A total of 100 HD patients with f-IDH treated in Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Traditional Chinese Medicine University from June 2020 to May 2021 were enrolled as the case group. By frequency matching method, 100 HD patients without f-IDH with the ratios of age, gender and diabetes comparable to those in the case group were enrolled as the control group. The risk factors for f-IDH were analyzed by logistic regression analysis, and the diagnostic value of pre-dialysis plasma osmolarity for f-IDH was evaluated by area under the receiver operating characteristic (ROC) curve (AUC). Results In the case group, serum parathyroid hormone (Z=-2.889, P=0.004), triglyceride (Z=-3.422, P=0.001), pre- dialysis plasma osmolarity (t=2.642, P=0.009), and average ultrafiltration volume/dry weight (t=3.700, P＜0.001) were higher than those in the control group, while serum albumin (t=2.402, P=0.018) was lower than that in the control group. Binary logistic regression analysis revealed that lower albumin (OR=0.847, 95% CI 0.723～0.992, P= 0.040), higher predialysis plasma osmolarity (OR=1.255, 95%CI 1.00～1.112, P=0.035) and higher average ultrafiltration volume/
dry weight (OR=1.719, 95% CI 1.225～2.412, P=0.002) were the independent risk factors for f-IDH in HD patients. ROC analysis showed that the AUC of pre-dialysis plasma osmolarity for the diagnosis of f-IDH was 0.702, with the cut-off value of 304.65 mOsm/Kg.H2O. Conclusion Higher pre-dialysis plasma osmolarity was an independent risk factors for f-IDH and can be used as a predictor for f-IDH in HD patients.
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