腹膜透析患者平均动脉压水平与死亡的关系

doi:10.3785/j.issn.1008-9292.2019.04.09

浙江大学学报（医学版）

2019, Vol. 48

Issue (2): 180-185 DOI: 10.3785/j.issn.1008-9292.2019.04.09

原著

腹膜透析患者平均动脉压水平与死亡的关系

吕朵^1,²(

),谢锡绍¹,张晓辉¹,陈江华^1,*(

)

1. 浙江大学医学院附属第一医院肾脏病中心, 浙江杭州 310003
2. 浙江大学医学院附属第一医院临床药学研究中心, 浙江杭州 310003

Associations of mean arterial pressure levels with mortality in patients with peritoneal dialysis

LYU Duo^1,²(

),XIE Xishao¹,ZHANG Xiaohui¹,CHEN Jianghua^1,*(

)

1. Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
2. Clinical Pharmacy Research Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China

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摘要：

目的: 探讨腹膜透析患者平均动脉压（MAP）水平与患者预后之间的关系。方法: 回顾性分析2008至2016年在浙江大学医学院附属第一医院开始腹膜透析的1737例终末期肾病患者的平均MAP水平，随访33.0（19.3，52.4）个月。取腹膜透析开始3个月内的MAP平均值作为基线MAP值。通过Cox比例风险模型和分数多项式回归模型分析MAP水平与腹膜透析患者全因死亡和心脑血管死亡之间的关系。结果: 随访过程中共有208例患者死亡，其中因心脑血管原因死亡95例，占45.7%。相比于MAP>95~ < 120 mmHg的腹膜透析患者，MAP ≤ 95 mmHg的腹膜透析患者全因死亡风险增高（HR=1.40，95%CI：1.01~1.93，P < 0.05），MAP ≥ 120 mmHg的患者全因死亡（HR=2.12，95%CI：1.32~3.40，P < 0.01）和心脑血管死亡风险均明显增高（HR=2.55，95%CI：1.38~4.70，P < 0.01）。腹膜透析患者MAP水平与患者全因死亡呈"U"型关系，与心脑血管死亡呈"J"型关系。结论: 高MAP和低MAP水平均会增加患者死亡的风险。

关键词： 肾功能衰竭, 慢性/治疗; 腹膜透析; 动脉压; 死亡; 心血管疾病; 回顾性研究

Abstract:

Objective: To investigate the associations between mean arterial pressure (MAP) and mortality in patients with peritoneal dialysis (PD). Methods: A total of 1737 patients with terminal renal diseases under PD in the First Affiliated Hospital of Zhejiang University from 2008 to 2016 were enrolled. Patients were followed up for 33.0(19.3, 52.4) months. The mean arterial pressure over the first 3 months of PD therapy were calculated. All-cause death and cardiovascular death were assessed using Cox regression models adjusted for demographics, laboratory measurements, comorbid conditions and antihypertensive medications. Results: During the follow-up, 208 patients died, among which 95(45.7%) patients died of cardiovascular causes. Compared with patients with MAP >95- < 120 mmHg, patients with MAP ≤ 95 mmHg were associated with significantly higher risk of all-cause death (HR=1.40, 95%CI:1.01-1.93, P < 0.05); patients with MAP ≥ 120 mmHg were associated with significantly higher risk of all-cause (HR=2.12, 95%CI:1.32-3.40, P < 0.01) and cardiovascular morality (HR=2.55, 95%CI:1.38-4.70, P < 0.01). MAP presents a U-shaped association with all-cause mortality and a J-shaped association with cardiovascular mortality. Conclusion: Both high MAP and low MAP are associated with higher risk of mortality in PD patients.

Key words: Kidney failure, chronic/therapy Peritoneal dialysis Arterial pressure Death Cardiovascular diseases Retrospective studies

收稿日期: 2019-01-10 出版日期: 2019-07-24

CLC:

R459.5

基金资助: 浙江省中医药优秀青年人才计划A类(2018ZQ029)

通讯作者: 陈江华 E-mail: lvduo8905@zju.edu.cn;zjukidney@zju.edu.cn

作者简介: 吕朵(1989-), 女, 硕士, 主要从事流行病与卫生统计学研究; E-mail:lvduo8905@zju.edu.cn; https://orcid.org/0000-0002-5528-8158

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引用本文:

吕朵,谢锡绍,张晓辉,陈江华. 腹膜透析患者平均动脉压水平与死亡的关系[J]. 浙江大学学报（医学版）, 2019, 48(2): 180-185.

LYU Duo,XIE Xishao,ZHANG Xiaohui,CHEN Jianghua. Associations of mean arterial pressure levels with mortality in patients with peritoneal dialysis. J Zhejiang Univ (Med Sci), 2019, 48(2): 180-185.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2019.04.09 或 http://www.zjujournals.com/med/CN/Y2019/V48/I2/180

表 1 不同平均动脉压(MAP)水平的患者一般临床资料比较

表 2 不同平均动脉压(MAP)水平的患者肾脏原发疾病构成比较

表 3 不同平均动脉压(MAP)水平的患者药物使用情况比较

表 4 平均动脉压(MAP)水平与腹膜透析患者全因死亡和心脑血管死亡的相关性分析结果

图 1 平均动脉压与全因死亡的分数多项式回归模型

图 2 平均动脉压与心脑血管死亡的分数多项式回归模型

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