郑州市维持性血液透析患者高血压患病情况及其影响因素

摘要

目的：探讨郑州市维持性血液透析患者高血压的患病情况及其相关影响因素。方法选取郑州市7家医院血液净化中心行维持性血液透析3个月以上，且病情稳定的尿毒症患者472例，根据血压控制情况分为3组：血压正常组、血压达标组及血压未达标组。比较3组的性别、年龄、原发病、透析时间、体质指数（ BMI）、降压药物种类、体重增加量、尿素氮（BUN）、肌酐（Cr）、尿酸（UA）、甲状旁腺激素（PTH）、血钙（Ca）、血磷（P）、钙磷乘积（Ca ×P）、三酰甘油（TG）、总胆固醇（TC）、血红蛋白（Hb）、白蛋白（Alb）及Kt／V等。结果（1）472例维持性血液透析中91.5％患者患有高血压，50.0％患者的血压控制未达标，其中单纯收缩压、舒张压升高者比例分别为61.4％、6.3％；（2）3组患者的年龄、性别构成、BMI、BUN、Cr、UA、TG、TC、Ca、P、Ca ×P、Alb等差异无统计学意义（P＞0.05）；（3）与血压正常组和血压达标组比较，血压未达标组的体重增加量及PTH较高，Kt／V较低，差异有统计学意义（P＜0.05）；与血压正常组比较，血压达标组的体重增加量较高，Kt／V较低，差异有统计学意义（P＜0.05）。结论维持性血液透析患者常合并高血压，其中以收缩压升高为主；透析间期体重增加过多、透析不充分（ Kt／V低）、高PTH是引起维持性血液透析患者血压控制不佳的危险因素。%Objective To investigate the prevalence and influencing factors of hypertension in maintenance hemo -dialysis ( MHD) patients in Zhengzhou .Methods 472 stable cases of uremia patients on MHD for more than three months from 7 blood purification centers in Zhengzhou were chosen .They were divided into three groups according to blood pressure (BP):the normal BP group, the well-controlled BP group and the poorly -controlled BP group.Gender, age, primary disease, dialysis time, body mass index (BMI), types of antihypertensive drugs , body weight gain, serum urea nitrogen (BUN), serum creatinine (Cr), uric acid (UA), parathyroid hormone (PTH), calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca ×P), triglycerides (TG), total cholesterol (TC), hemoglobin (Hb), albumin (Alb) and Kt/V were compared among the three groups .Results (1) 91.5% of 472 MHD patients suffered from hy-pertension.236 (50.0%) cases had poorly -controlled blood pressure, among them 145 (61.4%) patients with high systolic blood pressure , while 6.3%with high diastolic blood pressure .( 2 ) There was no significant difference in age , gender, BMI, BUN, Cr, UA, TG, TC, Ca, P, Ca ×P and Alb among the three groups.(3) Compared with other groups, body weight gain and PTH were higher in the poorly -controlled BP group, and Kt/V was lower (P<0.05). Body weight gain was higher and Kt/V was lower in the well -controlled BP group than the normal BP group (P<0.05). Conclusions Hypertension is common in MHD patients , the majority of whom present as high systolic pressure .Exces-sive weight gain during the interdialysis period , inadequate hemodialysis ( low Kt/V) as well as high PTH are risk factors to poor blood pressure control in MHD patients .