目的 探究透析充分性与维持性血液透析患者心血管结构功能指标的关系。 方法 回顾性收集四川大学华西第四医院门诊维持性血液透析患者的临床资料及连续12次透析治疗的血压(blood pressure,BP)。将血清尿素下降率(urea reduction rate,URR)≥65%及单室尿素清除率(single-pool urea clearance,spKt/V)≥1.2定义为充分透析。计算最大和最小BP差值(△BP)、平均实际变异(average real variation,ARV)等指标。采用多变量逐步线性回归和二元Logistic回归分析探索透析充分性对血压变异性、冠状动脉钙化等心血管并发症的影响。 结果 共纳入90例患者，年龄(59.8±17.4)岁，中位透析龄28.3(12.3，46.8)月。透析不充分者(45例)较充分者(45例)的透析期收缩压△BP(t=
-2.035,P=0.045)、收缩压ARV(t=-2.228,P=0.028)及冠状动脉钙化积分(t=-2.045,P=0.041)更高。年龄(β=0.305,P=0.003)、冠心病(β=-0.255,P=0.014)、spKt/V(β=-0.290,P=0.006)与透析期收缩压ARV水平相关。糖尿病(OR=6.048,95% CI：1.168～31.330,P=0.032)、低白蛋白水平(OR=0.817,95% CI：0.681～0.982,P=0.031)、低spKt/V(OR=0.886,95% CI：0.786～0.998,P=0.047)是钙化积分≥400的独立危险因素。 结论 透析不充分与维持性血液透析患者透析期收缩压变异性增高密切相关，并且是严重冠状动脉钙化的独立危险因素。
Objective To explore the relationships between dialysis adequacy and cardiovascular structure and function in patients with maintenance hemodialysis (MHD). Methods Clinical data with respect to blood biochemical examinations, vascular calcification and 12 consecutive dialysis treatments were retrospectively collected for patients receiving hemodialysis more than three months. Adequate dialysis was defined as the urea reduction rate (URR)≥65% and single-pool urea clearance (spKt/V)1.2. Blood pressure variability (BPV) metrics including the difference in maximum and minimum BPs (△BP) and average real variation (ARV) were calculated, and multivariate regression analyses were conducted. Results A total of 90 Chinese MHD outpatients were included, with the mean age of 59.8±17.4 years and the median dialysis vintage of 28.3(12.3～46.8) months. Patients with inadequate dialysis (45 patients) had higher intradialysis systolic ΔBP (27.9±6.6 vs. 25.1±6.5 mmHg, t=-2.035, P=0.045) and systolic BP-ARV [SBP-ARV (13.4 ± 3.4) vs. (11.9 ± 3.2)mmHg, t=-2.228, P=0.028] and greater coronary artery calcification score [CACs, 461.0(96.0～1741.0) vs. 99.5(1.0～1329.0), t=-2.045, P=0.041] than those with adequate dialysis (45 patients). Age (β=0.305, P=0.003), coronary heart disease (β= -0.255, P=0.014) and spKt/V (β= -0.290, P=0.006) were significantly correlated with intradialysis SBP-ARV; diabetes mellitus (OR= 6.048, 95% CI:1.168～31.330, P=0.032), low serum albumin levels (OR=0.817, 95% CI:0.681～0.982, P=0.031) and spKt/V (OR=0.886, 95% CI:0.786～0.998, P=0.047) were found to be independent risk factors for CACs≥400.Conclusions Inadequate dialysis was strongly associated with elevated intradialysis BPV and increased risk of severe coronary artery calcification in MHD patients.
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