【摘要】 目的探讨维持性血液透析患者透析间期血压对残余肾功能的影响。方法将2013年3月~2017年3月内蒙古科技大学包头医学院第一附属医院血液净化中心开始行血液透析的患者188例,开始透析3个月时进行胱抑素C(cystatin c,CysC)的检侧,同时开始检测透析间期一周血压,计算平均血压值,根据不同平均收缩压值分为3组:A组:平均收缩压<110mmHg(1mmHg=0.33kpa),B组:平均收缩压110~160mmHg,C组:平均收缩压>160mmHg;根据不同平均舒张压值再分为3组:a组:平均舒张压<60mmHg,b组:平均舒张压60~90mmHg,c组:平均舒张压>90mmHg。比较不同血压组间残余肾功能(residual renal function,RRF)(用血胱抑素C计算:RRF=0.70+22×1/CysC)有何不同。结果收缩压<110mmHg和>160mmHg组RRF明显低于110~160mmHg组(P<0.001),而收缩压<110mmHg组比收缩压>160mmHg组RRF更低,但无统计学差异(P=0.075),舒张压<60mmHg组的RRF明显低于舒张压在60~90mmHg组和舒张压>90mmHg组(P<0.001)。而舒张压在60~90mmHg组RRF明显高于舒张压>90mmHg组(P<0.001)。结论控制透析间期高血压,并防止透析间期低血压发生可能有助于保护残余肾功能。患者舒张压过低可能加速残余肾功能的降低。更多还原

【Abstract】 Objective To investigate the effect of interdialysis blood pressure on residual renal function(RRF) in hemodialysis patients. Methods A total of 188 patients treated in the Blood Purification Center,The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science & Technology and beginning hemodialysis during the period between Mar. 2013 and Mar. 2017 were recruited. At the 3 rd month of hemodialysis, cystatin C(CysC) was assayed and interdialysis blood pressure was measured for one week. Based on the average systolic blood pressure they were divided into group A: <110 mmHg, group B:110~160 mmhg and group C: >160 mmHg; based on the average diastolic blood pressure they were divided into group a: <60 mmHg, group b: 60~90 mmHg and group c: >90 mmHg as well. RRF was compared among different groups, and RRF was calculated from the equation RRF=0.70+22×1/CysC. Results RRF was significantly lower in group A and group C than in group B(P<0.001), and RRF was lower in group A than in group C, but without statistical difference(P=0.075). Moreover, RRF was significantly lower in group a than in group b and group c(P<0.001), and was lower in group c than in group b(P<0.001). Conclusion Maintenance of interdialysis blood pressure in a normal range and prevention of hypertension and hypotension can protect RRF. Lower diastolic blood pressure may accelerate the reduction of residual renal function.更多还原