维持性腹膜透析患者血压变异性与心血管事件发生相关性研究

    Blood pressure variability is associated with major adverse cardiovascular events in patients on maintenance peritoneal dialysis

    • 摘要: 目的 分析维持性腹膜透析患者一周血压变异性(blood pressure variability,BPV)与主要不良心血管事件的关系。方法 在南阳市中心医院腹膜透析中心2014年1月至2016年1月纳入85例透析时间大于3个月的腹膜透析患者,收集入院腹膜透析评估时的一周晨起血压以及其他临床资料,并根据中位血压变异系数,分为高BPV组(血压变异系数>11.0%)与低BPV组(血压变异系数≤ 11.0%),随访至2017年5月,监测两组主要不良心血管事件(心血管死亡、需住院治疗的心肌梗死、心绞痛、心力衰竭、卒中)的发生情况。结果 高BPV组与低BPV组透析相关指标(透析龄、Kt/V、日出液量)、原发病比例、钙磷代谢、血脂、血红蛋白及血白蛋白等指标,均无明显统计学差异。经中位随访15个月,腹膜透析患者主要不良心血管事件总发生率24.7%,其中心力衰竭发生率最高(15.3%)。高BPV组主要不良心血管事件总发生率(30.4%)高于低BPV组(17.9%),但并无统计差异(P=0.181)。腹膜透析患者无心血管事件中位存活时间30.5(27.2,33.8)个月,低BPV组无心血管事件存活时间33.9(30.1,37.8)个月高于高BPV组27.1(22.1,32.1)个月(χ2=4.649,P<0.05)。结论 维持性腹膜透析患者中,一周血压变异性与无心血管事件存活时间密切相关,血压变异性越高,无心血管事件存活时间相对越短。

       

      Abstract: Objective To investigate the association between one-week blood pressure variability (BPV) and major adverse cardiovascular events (MACEs) in patients on maintenance peritoneal dialysis. Methods A total of 85 patients undergoing maintenance peritoneal dialysis for at least 3 months in Nanyang Central Hospital from January 2014 to January 2016 were enrolled into our study. One-week morning blood pressures upon waking up and other clinical data obtained from peritoneal dialysis assessment upon admission were collected, and the patients were divided into the high BPV group (CV >11.0%) and low BPV group (CV ≤ 11.0%) based on the median coefficient of variation (CV) of the blood pressure data. All the patients were followed up until May 2017, so as to monitor incidences of MACEs (cardiovascular death, cardiovascular infarction required for hospitalization, angina pectoris, heart failure, stroke). Results In both of the high BPV group and low BPV group, dialysis related indices (dialysis age, Kt/V, daily dialysis effluent), proportion of primary cases, calcium and phosphorus metabolism, blood lipid, hemoglobin and blood albumin showed no statistically significant difference. Through median 15-month follow-up, it was found that the total incidence of MACEs was 24.7% in the patients on maintenance peritoneal dialysis, with the highest incidence of heart failure (15.3%). The total incidence of the high BPV group (30.4%) was higher than the low BPV group (17.9%), but with no statistical significance (P=0.181). The median survival time without adverse cardiovascular events for the peritoneal dialysis patients was 30.5 months (27.2, 33.8), and the survival time of 33.9 (30.1, 37.8) months for the low BPV group was higher than the time of 27.1 (22.1, 32.1) months for the high BPV group (Log rank test, χ2=4.649,P<0.05). Conclusions The blood pressure variability has close association with the survival time without adverse cardiovascular events in patients on maintenance peritoneal dialysis. The higher of the blood pressure variability, the shorter the survival time without adverse cardiovascular events.

       

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