维持性血液透析患者血压变异性对心功能的影响及相关因素分析

摘要

目的 通过对维持性血液透析患者(MHD)临床资料的研究,探讨MHD患者透析间期血压变异性(BPV)对心功能的影响,并对相关因素进行分析.方法 对2011年11月至2012年2月接受MHD治疗的60例患者进行横断面研究.根据患者透析间期44h的动态血压监测结果,按照夜间收缩压下降百分率的特点将患者分为非杓型组(33例)和反杓型组(27例).对两组患者透析间期44h的血压变化,透析前后的血尿素氮(BUN)、透析前的血清肌酐(Scr)、白蛋白(ALB)、血红蛋白(Hb)、胆固醇(CHOL)、甘油三酯(TG)、血清钠(Na)、血清磷(P)、血清钙(Ca)、钙磷乘积(Ca×P)、全段甲状旁腺激素(iPTH)水平以及超声心动图的各项参数进行比较.对上述生化指标与血压变异性之间的关系进行多元线性回归分析.结果 两组患者44h、日间、夜间的舒张压变异性,夜间收缩压变异性,夜间收缩压均值,收缩压和舒张压夜间下降率的差异均有统计学意义(P＜0.05).两组患者室间隔厚度和心率的差异具有统计学意义(P＜0.05).两组患者的44h舒张压变异性与iPTH、血清钠呈正相关,与血浆白蛋白呈负相关.结论 MHD患者存在血压节律的异常,呈现“非杓型”或“反杓型”血压,血压变异性受患者的营养状况、血钠水平和钙磷代谢情况的影响.透析间期血压呈“反杓型”者,心功能的损害更为严重.%Objective To explore the effect of dialysis interval blood pressure variability ( BPV) on cardiac function and analyze the related factors in maintenance hemodialysis (MHD) patients. Methods Sixty patients on MHD from Nov, 2011 to Feb, 2012 in our hospital were recruited for this cross - sectional study. According to the decline percentage of nocturnal systolic blood pressure ( SBP) measured by the dialysis interval 44 -hour ambulatory blood pressure monitoring, the patients were divided into reverse dipper or non - dipper group. The dialysis interval 44 - hour ambulatory blood pressure, the pre - and post - dialysis serum urea nitrogen (BUN), pre - dialysis hemoglobin (Hb), serum creatinine ( SCr) , cholesterol (CHOL) , triglyceride( TG) , albumin( ALB) , phosphorus( P) , calcium( Ca) , natrium ( Na) , intact parathyroid hormone ( iPTH) and cardiac function parameters measured by echocardiography were collected in both groups and multivariate regression analysis were performed. Results The nocturnal SBP mean value and variability, 44 - hour BPV, diurnal and nocturnal diastolic blood pressure ( DBP) variability were significantly different between two groups ( P < 0.05), as well as the nocturnal SBP and DBP decline rates ( P < 0.05). The interventricu-lar septal thickness (IVST) and heart rate were significantly different between the two groups ( P <0.05). For all patients, the 44 - hour DBP variability was positively correlated to iPTH and serum Na, and negatively correlated to serum ALB. Conclusion Blood pressure rhythm is presented as reverse dipper or non - dipper pattern in MHD patients. Those patients with reverse dipper pattern BP suffers from more severe cardiac function damage. BPV is correlated to nutrition status, serum Na and mineral metabolism in MHD patients.