上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2018, Vol. 38 ›› Issue (8): 910-.doi: 10.3969/j.issn.1674-8115.2018.08.009

• 论著·临床研究 • 上一篇    下一篇

临床常用指标在腹膜透析患者容量状态评估中的价值

苏新玙 *，刘苗 *，俞赞喆，严豪，李振元，张贺，袁江姿，倪兆慧，方炜   

  1. 上海交通大学医学院附属仁济医院肾脏科，上海市腹膜透析研究中心，上海 200127
  • 出版日期:2018-08-28 发布日期:2018-09-11
  • 通讯作者: 方炜，电子信箱：fangwei_sh@126.com。
  • 作者简介:苏新玙 (1991—)，女，博士生；电子信箱： 18801970644@163.com。刘苗 (1992—)，女，硕士生；电子信箱： miaomiaochloe@163.com。*为共同第一作者。
  • 基金资助:
    国家自然科学基金（ 81370864，81670691）；上海市教育委员会高峰高原学科建设计划（ 20152211）

Role of common clinical indicators in volume assessments of peritoneal dialysis patients

SU Xin-yu*, LIU Miao*, YU Zan-zhe, YAN Hao, LI Zhen-yuan, ZHANG He, YUAN Jiang-zi, NI Zhao-hui, FANG Wei   

  1. Shanghai Research Center for Peritoneal Dialysis, Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2018-08-28 Published:2018-09-11
  • Supported by:
    National Natural Science Foundation of China, 81370864, 81670691; Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Support, 20152211

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摘要： 目的 ·探讨临床常用指标在腹膜透析（简称腹透）患者容量评估中的应用价值。方法 ·选择 2016年 11月—2017年 11月于上海交通大学医学院附属仁济医院规律腹透的患者，收集患者人口统计学资料，检测临床指标，应用多频生物电阻抗技术测量超负荷液体量（ overhydration，OH），并分析其他临床指标与 OH的关系。结果 ·共有 200例患者入选该研究，其中男性 117例（58.5%），平均年龄（ 56.3±13.8）岁，中位透析龄 46.6个月， 42例（21.0%）患者合并糖尿病。该组患者中容量超负荷（ OH>1.1 L）患者共 141例（70.5%）。与容量正常患者相比，容量超负荷患者的血压、浮肿程度和脑钠肽（ brain natriuretic peptide，BNP）均明显升高（均 P<0.05）。容量超负荷患者中， 51例（36.2%）血压正常， 67例（47.5%）无浮肿， 46例（32.6%）BNP<100 pg/mL。容量正常患者中， 20例（33.9%）血压升高， 8例（13.6%）有浮肿， 1例（1.7%）BNP>400 pg/mL。收缩压、 BNP与 OH呈正相关（收缩压 r 0.361，P0.001；BNP r 0.615，P0.000）；浮肿程度越重的患者 OH越高（ P0.000）。结论 ·血压、浮肿程度及 BNP水平均与腹透患者容量状态密切相关，但单一临床指标并不能准确评估所有腹透患者容量状态，因此临床上应采用多种指标综合判断来评估腹透患者的容量状态。

关键词: 腹膜透析, 容量状态, 生物电阻抗, 血压, 浮肿程度, 脑钠肽

Abstract:

Objective · To investigate the role of common clinical indicators in volume assessments of peritoneal dialysis (PD) patients. Methods · Eligible PD patients in Renji Hospital, Shanghai Jiao Tong University School of Medicine Nov. 2016 to Nov. 2017 were enrolled. Demographic data of patients were collected and clinical parameters were measured. Hydration status index overhydration (OH) was measuredbioimpedance spectroscopy, and the association between clinical indicators and OH was analyzed. Results · A total of 200 PD patients aged 56.3±13.8 years with median PD duration of 46.6 months were enrolled in the study. Among them, 117 (58.5%) patients were males and 42 (21.0%) patients were diabetic. 141 (70.5%) patients in the present study were overhydrated (OH>1.1 L). Compared to those with normal hydration, the overhydrated patients had higher blood pressure, more obvious edema and higher brain natriuretic peptide (BNP) level (P<0.05). In the overhydrated patients, 51 (36.2%) patients had normal blood pressure, 67 (47.5%) patients had no edema and 46 (32.6%) patients had BNP less than 100 pg/mL. In the normal hydrated patients, 20 (33.9%) patients had high blood pressure, 8 (13.6%) patients had edema and 1 (1.7%) patient had BNP higher than 400 pg/mL. Systolic pressure and BNPlevel were both correlated with OH positively (systolic pressure r0.361, P0.001; BNP r0.615, P0.000).The patients who had more obviousedema also had higher OH(P0.000). Conclusion · Blood pressure, edema and BNP are closely associated with the hydration status, but only one of these clinical indicators can not accurately reflect the hydration status in all PD patients. Combination of different indicatorsmay be useful in evaluation of hydration status in PD patients.

Key words: peritoneal dialysis (PD), hydrationstatus, bioimpedance spectroscopy, bloodpressure, edema, brain natriuretic peptide (BNP)

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