血液透析中血压变异性随年龄变化特点及影响因素分析

    Analysis of the characteristics of intradialytic blood pressure variability with age and the relevant influencing factors

      摘要
    • 摘要: 目的 探讨不同年龄组维持性血液透析（maintenance hemodialysis，MHD）患者透析中血压变异性（blood pressure variability，BPV）差异和相关影响因素。方法 选取首都医科大学附属北京同仁医院MHD患者102例，根据年龄分为青年组（<45岁）32例，中年组（45≤，<60岁）26例和老年组（≥60岁）44例，BPV用多个血压读数的标准差（standard deviation，SD）和变异系数（coefficient of variation，CV）来表示。比较组间透析中BPV差异，分析影响BPV的相关因素。结果 与青年组比较，中年组和老年组中患糖尿病比例显著升高，血肌酐和白蛋白水平显著降低（P<0.05），老年组较青年组患者高敏C反应蛋白水平更高（P<0.05），与青年组和中年组比较，老年组血磷水平更低（P<0.05），而血红蛋白、全段甲状旁腺激素、血钙、Kt/V及服用≥3种降压药患者比例各组间比较差异均无统计学意义（P>0.05）。中年组和老年组患者透析前收缩压（SBP）、透析中SBP-SD和SBP-CV均显著高于青年组（P<0.05），老年组透析前和透析中舒张压（DBP）显著低于青年组和中年组（P<0.05）；与中年组比较，老年组透析中超滤量显著降低（P<0.05），透析中SBP和DBP-CV比较差异均无统计学意义（P>0.05）。采用多元逐步回归分析显示，糖尿病、女性与透析中SBP-CV呈正相关，血清白蛋白水平与其呈负相关（P<0.05）。结论 中年和老年MHD患者透析中收缩压变异性显著高于青年患者，提高血清白蛋白水平可能有助于降低透析中BPV。

       

      Abstract: Objective To explore the differences of intradialytic blood pressure variability(BPV)with age and the relevant influencing factors in maintenance hemodialysis(MHD)patients.Methods A total of 102 MHD patients were divided into three groups of young group(<45 years,n=32),middle-aged group(45-60 years,n=26)and elderly group(≥60 years,n=44).BPV was expressed by standard deviation(SD)and coefficient of variation(CV)of multiple blood pressure readings.The differences of intradialytic BPV were compared among three groups and the relevant factors were analyzed.Results As compared with young group,the proportion of diabetes mellitus increased markedly and the levels of serum creatinine and albumin declined obviously in middle-aged and elderly groups(P<0.05).The level of high-sensitivity C-reactive protein was higher in elderly group than that in young group(P<0.05).As compared with young and middle-aged groups,the serum level of phosphorus was lower in elderly group(P<0.05).No significant differences existed in hemoglobin,intact parathyroid hormone,total calcium,Kt/V or the proportion of taking three or four kinds of antihypertensive drugs among three groups(P>0.05).The mean pre-dialysis systolic blood pressure(SBP),intradialytic SBP-SD and SBP-CV were significantly higher in middle-aged and elderly groups than those in young group(P<0.05).The pre-dialysis and intradialytic diastolic blood pressure(DBP)were significantly lower in elderly group than those in young and middle-aged groups(P<0.05).As compared with middle-aged group,ultrafiltration volume decreased markedly in elderly group(P<0.05).No significant differences existed in intradialytic SBP or DBP-CV among three groups(P>0.05).Multivariate stepwise regression showed that diabetes and females were positively correlated with intradialytic SBP-CV while serum albumin was negatively correlated with intradialytic SBP-CV(P<0.05).Conclusion Intradialytic systolic blood pressure variability is significantly higher in middle-aged and elderly MHD patients than that in young MHD counterparts.And intradialytic BPV may be reduced by a higher serum level of albumin.

       

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