摘要：
目的 观察维持性血液透析(maintenance hemodialysis,MHD)患者透析前血压变异性(blood pressure variability,BPV),探讨其对远期预后的影响.方法 记录2011年3月1日至2011年5月31日共3个月中,南京市中心医院50例维持性血液透析患者的透析前收缩压、舒张压,计算其平均值及标准差,以血压离散系数表示血压变异性大小.同时记录患者一般情况、生化指标、心脏彩超检查结果.随访5年,记录患者生存状况及死亡原因.将所有患者根据生存状况分为死亡组及生存组,多因素二元Logistic回归分析BPV是否是死亡的独立危险因素.结果 透前收缩压变异性(systolic bloodpressure variability,SBPV)与舒张压变异性(diastolic blood pressure variability,DBPV)分别为(8.5±2.1)％、(9.3±2.8)％,5年后12名患者死亡,死亡率24.0％.单因素方差分析显示死亡组年龄(F=19.817,P＜0.001)、体质量指数(body mass index,BMI) (F=8.012,P=0.007)、左房内径(left atrialdiameter,LAD) (F=4.379,P=0.042)、室间隔厚度(interventricular septal thickness,IVS) (F=7.655,P=0.008)、SBPV (F=21.977,P＜0.001)、DBPV (F=22.433,P＜0.001)高于生存组,而死亡组平均收缩压(F=4.081,P=0.049)、舒张压(F=5.871,P=0.019)、透前血肌酐(F=8.375,P=0.006)水平较低,差异均具有统计学意义.经x2检验糖尿病组患者死亡率高于非糖尿病组(x2=5.852,P=0.016).将以上具有统计学意义的各单因素指标纳入多因素二元Logistic回归分析,以是否死亡作为因变量,结果年龄(OR=1.186,95°CCl1.108～1.381,P=0.028)、糖尿病(OR=3.250,95％Cl1.235～8.554,P=0.017)、SBPV(OR=2.622,95％Cl1.346～5.109,P=0.005)、DBPV(OR=2.147,95％Cl1.059～4.352,P=0.034)、血肌酐(OR=0.993,95％ Cl0.985～0.000,P=0.046)被引入回归方程,具有统计学意义.而平均收缩压、舒张压均未被引入方程.结论 透前SBPV及DBPV可能是MHD患者全因死亡的独立危险因素.%Objective Blood pressure variability (BPV) is a putative risk factor for cardiovascular disease and mortality in maintenance hemodialysis (MHD) patients.The purposes of this study are to determine whether pre-dialysis BPV correlates to all-cause mortality in this cohort of MHD patients.Methods A total of 50 MHD patients were enrolled in this study.During the period from March 1st,2011 to May 1st,2011,their systolic pressure (SBP) and diastolic pressure (DBP) were recorded before every dialysis session for 2 weeks,and the mean systolic pressure (SBP) and mean diastolic pressure (DBP) were calculated.BPV was expressed as coefficient of variability,and their survival status and the cause of death were recorded in the next 5 years.The patients were then divided into survival group and death group.Results Systolic blood pressure variability (SBPV) and diastolic blood pressure variability (DBPV) were 8.5±2.1％ and 9.3±2.8％,respectively.Twelve of the 50 patients (24.0％) died in the 5 years of follow-up period.Analyses using one-way ANOVA showed that age (F=19.817,P＜0.001),BMI (F=8.012,P=0.007),IVS (F=7.655,P=0.008),LAD (F=4.379,P=0.042),SBPV (F=21.977,P＜0.001) and DBPV (F=22.433,P＜0.001) were significantly higher in death group than in survival group.Meanwhile,SBP (F=4.081,P=0.049),DBP (F=5.871,P=0.019) and serum creatinine (F=8.375,P=0.006) were lower in death group than in survival group.Patients with diabetes had higher mortality than those without diabetes (c2=5.852,P=0.016).Multivariate binary logistic regression to analyze the statistically significant variables using death and survival as the dependent variables found that age (OR=1.186,95％ CI 1.108～1.381,P=0.028),diabetes (OR=3.250,95％ CI 1.235～8.554,P=0.017),serum creatinine (OR=0.993,95％ CI-0.985～0.000,P=0.046),SBPV (OR=2.622,95％ CI 1.346～5.109,P=0.005) and DBPV (OR=2.147,95％ CI 1.059～4.352,P=0.034) were independently correlated with all-cause mortality.SBP and DBP were not included in the regression analyses.Conclusion Pre-dialytic SBPV and DBPV may be the independent risk factors for all-cause mortality in MHD patients.
