维持性血液透析合并高血压患者难治性高血压的影响因素分析

Influence factors of refractory hypertension in patients with maintenance hemodialysis and hypertension

摘要:

目的  探讨维持性血液透析（MHD）合并高血压（HTN）患者难治性高血压（RH）的影响因素。方法  对四川省泸州市3家大型医院血液透析（HD）中心的225例MHD合并HTN患者进行横断面调查。其中RH患者70例，非RH患者155例，记录患者的年龄、性别、血压、血电解质、血红蛋白、干体重等临床资料，并运用单因素和多因素Logistic回归分析MHD合并HTN患者RH的影响因素。结果  MHD合并HTN患者RH患病率为31.1%，MHD合并HTN患者RH组HD前血钠浓度≥140 mmol/L的比例、尿素清除指数（Kt/V）<1.2的比例、血甲状旁腺激素（PTH）≥150 ng/L的比例以及血液灌流（HP）<2 h/月比例均高于非RH患者（P <0.05），而干体重达标率低于非RH患者（P <0.05），多因素Logistic回归分析显示，MHD合并HTN患者发生RH与Kt/V、血PTH以及HP频率独立相关。结论  MHD合并HTN患者RH的患病率高；Kt/V<1.2、血PTH≥150 ng/L、HP频率<2 h/月是MHD合并HTN患者RH的影响因素。

Abstract:

Objective To discuss the influence factors of refractory hypertension (RH) in the maintenance hemodialysis (MHD) patients combined with hypertension. Methods The present study was a cross-sectional study about 225 maintenance hemodialysis patients combined with hypertension in the hemodialysis centers of three large-scale hospitals in Luzhou City. There were 70 patients combined with refractory hypertension (RH group) and 155 patients without refractory hypertension (non-RH group). The clinical data of the patients such as age, sex, blood pressure, blood electrolytes, hemoglobin, dry weight, and so on were recorded. Univariate and multivariate logistic regression analyses were used to explore the influence factors of refractory hypertension in the maintenance hemodialysis patients combined with hypertension. Results The occurrence of refractory hypertension in the maintenance hemodialysis patients combined with hypertension was 31.1%. In the RH group, the proportions of the patients with pre-HD serum sodium concentration ≥ 140 mmol/L, Kt/V < 1.2, parathyroid hormone level ≥ 150 ng/L, and the time of hemoperfusion < 2 h/month were higher than those inthe non-RH group (P < 0.05), but the proportion of patients with standard dry weight was lower than that in the non-RH group (P < 0.05). Multivariate logistic regression analysis indicated that Kt/V, parathyroid hormone and the frequency of hemoperfusion were independently associated with refractory hypertension in the maintenance hemodialysis patients combined with hypertension. Conclusions The occurrence of refractory hypertension is high in the maintenance hemodialysis patients combined with hypertension. Kt/V < 1.2, parathyroid hormone level ≥150 ng/L, and hemoperfusion frequency less than 2 hours per month are the influencing factors of refractory hypertension in the maintenance hemodialysis patients combined with hypertension.