糖尿病肾病致终末期肾病维持性血液透析患者高血压的多中心临床研究

发布时间：2018-02-01 04:34

  本文关键词： 血液透析 糖尿病肾病 高血压　出处：《上海医学》2017年01期 　论文类型：期刊论文

【摘要】：目的探讨糖尿病肾病(DKD)所致终末期肾病(ESRD)行维持性血液透析(MHD)患者的高血压情况。方法收集上海市39家血液透析中心558例DKD所致ESRD行MHD患者的高血压相关临床和实验室检查资料,并进行统计学分析。结果 558例患者中高血压患者共523例,患病率为93.7%。不同性别间高血压患病率、收缩压和舒张压的差异均无统计学意义(P值均0.05)。接受抗高血压药物治疗的患者共490例,应用药物治疗比例为93.7%(490/523),不同性别间高血压治疗率的差异均无统计学意义(P0.05)。使用的降压药物以钙通道阻滞剂(CCB)最多(366例,占74.7%),其次为血管紧张素受体阻滞剂(ARB,166例,占33.9%)和血管紧张素转换酶抑制剂(ACEI,95例,占19.4%)。应用1种药物以CCB最为常用,应用2种药物以CCB联合ARB最为常用。128例(24.5%)患者达到血压控制靶目标(≤140/90 mmHg,1 mmHg=0.133kPa),不同性别间血压控制率的差异无统计学意义(P0.05)。血压控制组的年龄显著大于血压未控制组(P0.05),尿素清除指数(KT/V)、尿素清除率(URR)、血红蛋白水平显著高于血压未控制组(P值均0.05),高血压用药种类显著少于血压未控制组(P0.05)。单因素Logistic分析发现,高血压用药种类为血压控制的危险因素(OR=1.34,95%CI为1.07~1.69,P0.05),年龄(OR=0.96,95%CI为0.94~0.98,P0.05)和血红蛋白水平(OR=0.98,95%CI为0.97~0.99,P0.05)为血压控制的保护因素。逐步多因素Logistic回归分析发现,患者血压控制与年龄、高血压用药种类和血红蛋白水平显著相关,回归系数分别为-0.40、0.24、-0.02(P值均0.05),年龄越小、高血压用药种类越多、血红蛋白水平越低,血压控制越不理想。结论 DKD所致ESRD行MHD患者的高血压患病率和治疗率均较高,但血压控制率较低,血压控制受年龄、血红蛋白水平、高血压用药种类等多种因素影响。
[Abstract]:Objective to investigate the effect of maintenance hemodialysis (MHD) on end-stage nephropathy (ESRD) induced by diabetic nephropathy (DKD). Methods the clinical and laboratory data of 558 ESRD patients with MHD caused by DKD in 39 hemodialysis centers in Shanghai were collected. Results there were 523 cases of hypertension in 558 patients, the prevalence rate was 93.7%. There was no significant difference in systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P < 0.05). 490 patients were treated with antihypertensive drugs and the proportion of patients treated with drugs was 93.790 / 523). There was no significant difference in the treatment rate of hypertension between sexes (P 0.05). The most common antihypertensive drugs were calcium channel blocker CCB in 366 cases (74.775%). The second was angiotensin receptor blocker (ARBN) in 166 cases (33. 9%) and angiotensin converting enzyme inhibitor (ACEI) in 95 cases. 19.4%. CCB is the most commonly used drug. The target of blood pressure control (鈮，

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