影响糖尿病维持性血液透析患者透析中低血压的因素分析

doi:10.3969/j.issn.1006-7795.2025.05.015

首都医科大学学报 ›› 2025, Vol. 46 ›› Issue (5): 860-865.doi: 10.3969/j.issn.1006-7795.2025.05.015

影响糖尿病维持性血液透析患者透析中低血压的因素分析

姚为华^1#,张丽玲^2#,刁宗礼³, 宋洞琪⁴,高茜⁵,刘文虎^3*

1.北京核工业医院肾内科，北京 102413;2.厦门大学附属妇女儿童医院（厦门市妇幼保健院）急诊科，厦门 361000; 3.首都医科大学附属北京友谊医院肾内科，北京 100032;4.北京市大兴区人民医院肾内科，北京 102600;5.北京中能建医院肾内科，北京 102401

收稿日期:2024-08-12 修回日期:2025-04-08 出版日期:2025-10-21 发布日期:2025-10-22
通讯作者: 刘文虎 E-mail:wenhuliu@mail.ccmu.edu.cn
基金资助:
北京市自然科学基金项目(7232036,7232030)。

Analysis of the influencing factors for intradialytic hypotension in diabetic maintenance hemodialysis patients

Yao Weihua^1#, Zhang Liling^2#, Diao Zongli³, Song Dongqi⁴, Gao Qian⁵, Liu Wenhu^3*

1.Department of Nephrology, Beijing Nuclear Industry Hospital, Beijing 102413, China;2.Department of Emergency, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen 361000, China; 3.Department of Nephrology, Beijing Friendship Hospital,Capital Medical University, Beijing 100032, China; 4.Department of Nephrology, People's Hospital of Beijing Daxing District, Beijing 102600, China; 5.Department of Nephrology, Beijing Zhong Neng Jian Hospital, Beijing 102401, China

Received:2024-08-12 Revised:2025-04-08 Online:2025-10-21 Published:2025-10-22
Supported by:
This study was supported by the Natural Science Foundation of Beijing(7232036,7232030).

摘要/Abstract

摘要： 目的研究糖尿病维持性血液透析(maintenance hemodialysis, MHD)患者发生透析中低血压(intradialytic hypotension, IDH)的影响因素，为临床IDH的预防和质量控制提供参考。方法收集2022年3月至2022年9月北京4家血液透析中心的200例糖尿病患者为研究对象，根据IDH定义［血液透析期间收缩压≤90 mmHg (1 mmHg=0.133 kPa)或透析期收缩压降低≥30 mmHg］将患者分为IDH组（随访7个月，透析治疗期间发生低血压事件频率≥30%）和非IDH组。采用单因素分析筛选，多因素Logistic回归分析IDH的影响因素。采用受试者工作特征(receive operating characteristic，ROC)曲线分析评价各影响因素对IDH的预测价值。结果单因素分析显示，IDH组与非IDH组比较，透析前收缩压更高、血糖更高、血白蛋白更低(P<0.05)；IDH组合并体位性低血压的患者多于非IDH组(P<0.05)。多因素Logistic回归分析显示，透析前收缩压、体位性低血压和血白蛋白均为IDH的影响因素(P<0.05)。ROC分析评价透析前收缩压对IDH的诊断准确性,曲线下面积为0.787 (95% CI: 0.720～0.854, P<0.001)，根据约登指数预测IDH的阈值为153 mmHg，灵敏度为75.5%，特异度为75.4%。结论血液透析前收缩压、血白蛋白、体位性低血压是糖尿病患者发生IDH的独立影响因素。为了预防IDH的发生，血液透析前收缩压阈值为153 mmHg。

关键词: 糖尿病, 血液透析, 透析中低血压, 透析前收缩压, 体位性低血压, 血白蛋白, 血糖

Abstract: Objective To study the influencing factors of intradialytic hypotension (IDH) in diabetic maintenance hemodialysis (MHD) patients, and to provide references for clinical prevention of IDH quality control. Methods A total of 200 diabetic patients from four hemodialysis centers in Beijing from March 2022 to September 2022 were collected as the research objects. According to the definition of IDH ［systolic blood pressure during hemodialysis≤90 mmHg (1 mmHg=0.133 kPa) or systolic blood pressure reduction during dialysis≥30 mmHg］, the patients were divided into IDH group ( frequency of hypotension events during dialysis ≥30 % during 7 months of follow-up) and non-IDH group. Univariate analysis and multivariate Logistic regression were used to analyze the influencing factors of IDH. receive operating characteristic curve(ROC) curve analysis was used to evaluate the predictive value of each influencing factor for IDH. Results Univariate analysis showed that compared with non-IDH group, IDH group had higher systolic blood pressure, higher blood glucose and lower serum albumin before dialysis (P<0.05). There were more patients with orthostatic hypotension in the IDH group than in the non-IDH group (P <0.05). Multivariate Logistic regression analysis showed that pre-dialysis systolic blood pressure, orthostatic hypotension and serum albumin were the influencing factors of IDH (P<0.05). ROC curve was used to evaluate the diagnostic accuracy of pre-hemodialysis systolic blood pressure for IDH. The area under the ROC curve was 0.787 (95% CI: 0.720-0.854, P<0.001), the threshold of IDH predicted by the Jorden index was 153 mmHg, the sensitivity was 75.5%, and the specificity was 75.4%. Conclusion Pre-hemodialysis systolic blood pressure, blood albumin and postural hypotension are independent factors of IDH in diabetic patients. In order to predict the occurrence of IDH, the pre-hemodialysis systolic blood pressure threshold was 153 mmHg.

Key words: diabetes mellitus, hemodialysis, intradialytic hypotension, pre-hemodialysis systolic blood pressure, postural hypotension, blood albumin, blood glucose

中图分类号:

R544.2

姚为华, 张丽玲, 刁宗礼, 宋洞琪, 高茜, 刘文虎. 影响糖尿病维持性血液透析患者透析中低血压的因素分析[J]. 首都医科大学学报, 2025, 46(5): 860-865.

Yao Weihua, Zhang Liling, Diao Zongli, Song Dongqi, Gao Qian, Liu Wenhu. Analysis of the influencing factors for intradialytic hypotension in diabetic maintenance hemodialysis patients[J]. Journal of Capital Medical University, 2025, 46(5): 860-865.

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影响糖尿病维持性血液透析患者透析中低血压的因素分析

Analysis of the influencing factors for intradialytic hypotension in diabetic maintenance hemodialysis patients

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