摘要
目的比较维持性腹膜透析(MPD)患者和维持性血液透析(MHD)患者血压变异性(BPV)和血压节律性(BPR)的差异,探讨BPV和BPR与心血管疾病(CVD)死亡的关系。方法本研究为前瞻性队列研究。纳入2015年12月至2016年7月在宁夏医科大学总医院肾脏内科血液净化中心接受规律维持性透析治疗3个月以上且临床状况稳定的患者。收集患者的一般资料、生化指标及透析相关指标。所有患者均行动态血压监测观察BPV和BPR,前瞻性随访截至2020年2月。根据全部患者的24 h收缩压变异性(24hSBPV)中位数分为高24hSBPV组与低24hSBPV组,比较两组患者的基线资料。比较MPD和MHD患者的BPV、BPR。患者的生存分析采用Kaplan-Meier法。采用Cox回归分析法分析BPV与CVD死亡的关系。结果共纳入120例透析患者,男性76例(63.33%),年龄(50.89±14.61)岁,中位透析龄42(28,58)个月。高24hSBPV组和低24hSBPV组患者各60例,两组患者总尿素清除指数、使用钙通道阻滞剂和β受体阻滞剂比例的差异均有统计学意义(均P<0.05),年龄、性别、原发病、CVD、血红蛋白、血钙、血磷、估算肾小球滤过率、血尿酸、血全段甲状旁腺素、血清铁等方面的差异无统计学意义。MHD患者24hSBPV明显高于MPD患者[(13.92±3.79)mmHg比(12.49±3.99)mmHg,t=2.01,P=0.041]。所有患者血压昼夜节律异常发生率高达93.33%(112/120),并以非勺型血压为主(101例,84.17%)。MHD和MPD患者血压节律异常比例的差异无统计学意义。中位随访42.00(14.25,42.00)个月,共发生60例(50.00%)CVD事件,其中CVD死亡31例(25.83%)。校正年龄、性别、体重指数、血清肌酐、血红蛋白、尿酸、超敏C反应蛋白等混杂因素后,多因素Cox回归分析结果显示,高24hSBPV是MHD患者和MPD患者发生CVD死亡的独立影响因素(MHD:HR=1.25,95%CI 1.06~1.47,P=0.007;MPD:HR=1.24,95%CI 1.09~1.40,P=0.001)。结论MHD患者的24hSBPV较MPD患者高。在MHD及MPD患者中,随着24hSBPV的增加,CVD发生的风险增高,高24hSBPV是MHD和MPD患者发生CVD死亡的独立影响因素。
Objective To compare the differences of blood pressure variability(BPV)and blood pressure rhythm(BPR)between maintenance peritoneal dialysis(MPD)and maintenance hemodialysis(MHD)patients,and explore the relationship of BPV and BPR with cardiovascular disease(CVD)-related death.Methods This was a prospective cohort study.Patients with maintenance dialysis treatment for more than 3 months in the General Hospital of Ningxia Medical University and stable clinical status were recruited from December 2015 to July 2016.The patients'general data,biochemical indexes and dialysis-related indexes were collected.BPV and BPR were observed by ambulatory blood pressure monitoring in all patients.The prospective follow-up was up to February 2020.All patients were divided into high 24 h systolic blood pressure variability(24hSBPV)group and low 24hSBPV group based on the median of 24hSBPV,and the baseline data of the two groups were compared.The BPV and BPR between MPD and MHD patients were compared.Kaplan-Meier method was used for survival analysis.The relationship between BPV and CVD-related death was analyzed by Cox regression.Results A total of 120 dialysis patients were included in the study,including 76 males(63.33%).The age was(50.89±14.61)years old and the median dialysis age was 42(28,58)months.There were 60 patients in the high 24hSBPV group and 60 patients in the low 24hSBPV group,and the differences in total Kt/V(urea clearance),calcium channel blocker andβ-blockerrs between the two groups were statistically significant(all P<0.05).There were no statistically significant differences in age,gender,primary disease,CVD,hemoglobin,blood calcium,blood phosphorus,estimated glomerular filtration rate,blood uric acid,intact parathyroid hormone,serum iron and so on between the two groups.24hSBPV in MHD patients was significantly higher than that in MPD patients[(13.92±3.79)mmHg vs(12.49±3.99)mmHg,t=2.01,P=0.041].The incidence of abnormal circadian rhythm of blood pressure in all patients was 93.33%(112/120),and non-dipper blood pressure accounted for 84.17%(101/120).There was no significant difference in BPR between the MPD and MHD patients.With follow-up of 42.00(14.25,42.00)months,a total of 60 cases(50%)CVD events occurred,of which there were 31 cases(25.83%)CVD-related death.The multivariate Cox regression analysis showed that the high 24hSBPV was an independent influencing factor for CVD-related death in patients with MHD and MPD after the confounding factors(ages,sex,body mass index,serum creatinine,hemoglobin,uric acid,hypersensitivity C-reactive protein and so on)were corrected(HR=1.25,95%CI 1.06-1.47,P=0.007;HR=1.24,95%CI 1.09-1.40,P=0.001).Conclusions The 24hSBPV in MHD patients is higher than that in MPD patients.With the increase of 24hSBPV,the risk of CVD increases in patients with MHD and MPD.24hSBPV is an independent influencing factor for CVD-related death in both MHD and MPD patients.
作者
王梦婷
李璐
褚睿
王丽
徐梅
朱月萍
田娜
陈孟华
Wang Mengting;Li Lu;Chu Rui;Wang Li;Xu Mei;Zhu Yueping;Tian Na;Chen Menghua(Department of Nephrology,General Hospital of Ningxia Medical University,Ningxia Kidney Disease Clinical Research Center,Yinchuan 750004,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2020年第12期925-935,共11页
Chinese Journal of Nephrology
基金
2020年宁夏回族自治区卫生健康系统科研课题(No.13)
宁夏回族自治区2018年重点研发项目(2018BEG03036)。
关键词
腹膜透析
肾透析
心血管疾病
血压变异性
血压节律性
Peritoneal dialysis
Renal dialysis
Cardiovascular disease
Blood pressure variability
Blood pressure rhythm
