目的探讨糖尿病患者透析中低血压(intradialytichypotension，IDH)的影响因素。方法选择2017年1月～2019年12月北京3家血液透析中心的糖尿病患者140例，根据IDH的发生频率是否超过30%分为IDH组和非IDH组，记录患者的临床资料，分析2组患者IDH的影响因素。结果IDH组101人，非IDH组39人。Logistic回归分析显示超滤率、透析前收缩压是IDH的独立影响因素，OR值和95%CI：分别为：1.229(1.017～1.487)，P=0.033；1.048(1.013～1.083)，P=0.007。ROC曲线预测IDH，透析前收缩压的阈值为159mmHg(1mmHg=0.133kPa)(AUC=0.702，95%CI：0.604～0.801,P＜0.001)；超滤率的阈值为9.5ml/(h·kg)(AUC=0.657，95%CI：0.551～0.762,P=0.004)。结论超滤率、透析前收缩压是糖尿病患者发生IDH的危险因素，建议透析前收缩压质量控制的上限阈值为159mmHg，超滤率的质量控制上限阈值为9.5ml/(h·kg)。
Objectives To explore the influencing factors for intradialytic hypotension (IDH) in diabetic patients with maintenance hemodialysis (MHD). Methods A total of 140 diabetic patients on MHD during January 2017 to December 2019 were recruited from three hemodialysis centers in Beijing. They were divided into two group: IDH group (IDH episodes in more than 30% of dialysis sessions), and non-IDH group (IDH episodes in less than 30% dialysis sessions). Their clinical and laboratory data were collected and the potential impact factors for IDH were evaluated. Results There were 101 cases in IDH group and 39 case in non-IDH group. Logistic regression analysis showed that ultrafiltration rate (OR=1.229, 95% CI 1.017~1.487, P=0.033) and pre-hemodialysis systolic blood pressure (OR=1.048, 95% CI 1.013~1.083, P=0.007) were the independent influencing factors for IDH. ROC for the prediction of IDH demonstrated that the threshold of pre-hemodialysis systolic blood pressure was 159mmHg (AUC=0.702, 95% CI 0.604~0.801, P<0.001) and the threshold of ultrafiltration rate was 9.5ml/h/kg (AUC=0.657, 95% CI 0.551~0.762, P=0.004). Conclusions Pre-hemodialysis systolic blood pressure and ultrafiltration rate were the risk factors for IDH in diabetic patients with MHD.
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