生物电阻抗评估调整干体重对血液透析患者血压和心功能的影响
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摘要
目的观察通过多频生物电阻抗评估调节不同干体重对血液透析(HD)高血压患者血压和心脏功能的影响。方法选择泰安市中心医院肾内科2017年1月至2018年3月间维持性HD患者96例为HD组,选择106名健康体检者为健康对照组,测定各组细胞内液(ICW)、细胞外液(ECW)、细胞外液/总体液量(ECW/TBW)等生物电阻抗值进行比较。选取透析后生物电阻抗高于健康对照组的HD患者79例作为干体重调整组(DWAG),根据生物电阻抗调整干体重3个月,分别于调整前后检测DWAG组患者透析后的体质量、血压、多频生物电阻抗及心脏彩超等指标。采用t检验比较HD组与健康对照组一般资料差异,采用单因素方差分析比较健康对照组与HD组患者透析前后ICW、ECW、ECW/TBW差异,DWAG患者干预前后的相关指标比较采用配对t检验。结果 HD组患者透析前后ICW、ECW、ECW/TBW均高于健康对照组[(27.49±3.96)L vs (26.36±3.93)L vs(23.91±4.92)L;(18.42±2.66)L vs (17.07±3.03)L vs (15.99±4.23)L;(41.03±2.03)%vs(39.73±3.64)%vs (37.59±4.63)%],差异均具有统计学意义(t=5.660、4.829、6.717,P均<0.001;t=3.884、2.067、3.626,P <0.001、=0.040、<0.001);与透析前相比较,透析后HD组患者的电阻抗值较透析前显著下降,差异具有统计学意义(t=1.984,P=0.049;t=3.281,P=0.001;t=3.056,P=0.003)。干体重调整后DWAG患者的ICW、ECW、ECW/TBW低于调整前[(26.11±2.97)L vs(28.09±4.17)L;(17.01±1.98)L vs (19.06±2.77)L;(38.97±3.19)%vs (40.49±2.57)%],差异具有统计学意义(t=7.502,9.406,5.655,P均<0.001);DWAG患者调整后收缩压和舒张压也分别较调整前下降[(148.52±7.31)mmHg vs (157.14±9.97)mmHg;(87.67±12.84)mmHg vs(92.30±11.71)mmHg],差异具有统计学意义(t=8.641,4.193,P均<0.001)。心功能检测显示DWAG组患者LAD、LVDd、IVSd、LVPWd分别较调整前下降[(43.23±5.90)mm vs (43.47±5.82)mm;(48.76±6.42)mm vs (49.58±5.39)mm;(10.29±1.03)mm vs (10.45±0.79)mm;(10.53±1.04)mm vs (10.60±0.92)mm],差异具有统计学意义(t=3.128,P=0.0002;t=2.251,P=0.027;t=2.560,P=0.012;t=2.221,P=0.029),而LVEF较调整前提高[(64.63±4.47)%vs(63.51±3.40)%],差异具有统计学意义(t=-3.569,P=0.001)。结论参照多频生物电阻抗调整患者干体重可显著降低HD患者的血压,改善患者的心功能。
Objective To modulate dry weight by bioimpedance analysis and evaluate its effect on hypertension and cardiac function in hemodialysis(HD) patients. Methods Ninety-six maintenance HD patients at Department of Nephrology of Taian City Central Hospital were enrolled in an HD group, and 106 healthy cases were included as a control group. Both groups underwent multi frequency bioimpedance spectroscopy to measure the intracellular water(ICW), ECW(extracellular water) and ECW/total body water(TBW). Seventy-nine HD patients of the HD group which had higher bioimpedance than the control group were selected as a group for dry weight adjustment(DWAG). Post-dialysis weight, blood pressure,bioimpedance and heart Doppler ultrasound of DWAG were measured before and after the adjustment of the dry weight. Comparisons of the general data between the control group and HD group were performed by the independent t-test. Evaluation of the data between the control group and HD group before and after HD was carried out by one-way analysis of variance(ANOVA). Evaluation of the data within the DWAG before and after adjustment was carried out by the paired t-test. Results The ICW, ECW and ECW/TBW of the HD group before and after HD were all significantly higher than those of the control group [(27.49±3.96) L vs(26.36±3.93) L vs(23.91±4.92) L;(18.42±2.66) L vs(17.07±3.03) L vs(15.99±4.23) L;(41.03±2.03)%vs(39.73±3.64)% vs(37.59±4.63)%](t=5.660, 4.829, 6.717, P < 0.001 for all; t=3.884, 2.067,3.626, P < 0.001, =0.040, < 0.001). The ICW, ECW and ECW/TBW of the study group after HD were significantly lower than those before HD(t=1.984, P=0.049; t=3.281, P=0.001; t=3.056, P=0.003). ICW,ECW and ECW/TBW of the DWAG after dry weight adjustment were significantly lower than those before[(26.11±2.97) L vs(28.09±4.17) L, t=7.502, P < 0.001;(17.01±1.98) L vs(19.06±2.77) L, t=9.406,P < 0.001;(38.97±3.19)% vs(40.49±2.57)%, t=5.655, P < 0.001]. Systolic pressure and diastolic pressure of the DWAG significantly decreased after dry weight adjustment [(148.52±7.31) mmHg vs(157.14±9.97) mmHg, t=8.641, P < 0.001;(87.67±12.84) mmHg vs(92.30±11.71) mmHg, t=8.641,P < 0.001]. Cardiac function test showed that the left atrial diameter, left ventricular end diastolic diameter,interventricular septum thickness at end-diastole and left ventricular posterior wall depth of the DWAG significantly decreased after dry weight adjustment [(43.23±5.90) mm vs(43.47±5.82) mm, t=3.128,P=0.0002;(48.76±6.42) mm vs(49.58±5.39) mm, t=2.251, P=0.027;(10.29±1.03) mm vs(10.45±0.79) mm, t=2.560, P=0.012;(10.53±1.04) mm vs(10.60±0.92) mm, t=2.221, P=0.029]. However, LVEF of the DWAG significantly increased after dry weight adjustment [(64.63±4.47)% vs(63.51±3.40)%,t=-3.569, P=0.001). Conclusion Adjustment of dry weight based on multifrequency bioimpedance spectroscopy decreases blood pressure and improves cardiac function of HD patients.
Objective To modulate dry weight by bioimpedance analysis and evaluate its effect on hypertension and cardiac function in hemodialysis(HD) patients. Methods Ninety-six maintenance HD patients at Department of Nephrology of Taian City Central Hospital were enrolled in an HD group, and 106 healthy cases were included as a control group. Both groups underwent multi frequency bioimpedance spectroscopy to measure the intracellular water(ICW), ECW(extracellular water) and ECW/total body water(TBW). Seventy-nine HD patients of the HD group which had higher bioimpedance than the control group were selected as a group for dry weight adjustment(DWAG). Post-dialysis weight, blood pressure,bioimpedance and heart Doppler ultrasound of DWAG were measured before and after the adjustment of the dry weight. Comparisons of the general data between the control group and HD group were performed by the independent t-test. Evaluation of the data between the control group and HD group before and after HD was carried out by one-way analysis of variance(ANOVA). Evaluation of the data within the DWAG before and after adjustment was carried out by the paired t-test. Results The ICW, ECW and ECW/TBW of the HD group before and after HD were all significantly higher than those of the control group [(27.49±3.96) L vs(26.36±3.93) L vs(23.91±4.92) L;(18.42±2.66) L vs(17.07±3.03) L vs(15.99±4.23) L;(41.03±2.03)%vs(39.73±3.64)% vs(37.59±4.63)%](t=5.660, 4.829, 6.717, P < 0.001 for all; t=3.884, 2.067,3.626, P < 0.001, =0.040, < 0.001). The ICW, ECW and ECW/TBW of the study group after HD were significantly lower than those before HD(t=1.984, P=0.049; t=3.281, P=0.001; t=3.056, P=0.003). ICW,ECW and ECW/TBW of the DWAG after dry weight adjustment were significantly lower than those before[(26.11±2.97) L vs(28.09±4.17) L, t=7.502, P < 0.001;(17.01±1.98) L vs(19.06±2.77) L, t=9.406,P < 0.001;(38.97±3.19)% vs(40.49±2.57)%, t=5.655, P < 0.001]. Systolic pressure and diastolic pressure of the DWAG significantly decreased after dry weight adjustment [(148.52±7.31) mmHg vs(157.14±9.97) mmHg, t=8.641, P < 0.001;(87.67±12.84) mmHg vs(92.30±11.71) mmHg, t=8.641,P < 0.001]. Cardiac function test showed that the left atrial diameter, left ventricular end diastolic diameter,interventricular septum thickness at end-diastole and left ventricular posterior wall depth of the DWAG significantly decreased after dry weight adjustment [(43.23±5.90) mm vs(43.47±5.82) mm, t=3.128,P=0.0002;(48.76±6.42) mm vs(49.58±5.39) mm, t=2.251, P=0.027;(10.29±1.03) mm vs(10.45±0.79) mm, t=2.560, P=0.012;(10.53±1.04) mm vs(10.60±0.92) mm, t=2.221, P=0.029]. However, LVEF of the DWAG significantly increased after dry weight adjustment [(64.63±4.47)% vs(63.51±3.40)%,t=-3.569, P=0.001). Conclusion Adjustment of dry weight based on multifrequency bioimpedance spectroscopy decreases blood pressure and improves cardiac function of HD patients.
引文
1 Seibert E,Zhu F,Kuhlmann MK,et al.Slope-analysis of blood volume and calf-bioimpedance monitoring in hemodialysis patients[J].Nephrol Dial Transplant,2012,27(12):4430-4436.
2 Zhu F,Kotanko P,Handelman GJ,et al.Estimation of normal hydration in dialysis patients using whole body and calf bioimpedance analysis[J].Physiol Meas,2011,32(7):887-902.
3 Chamney PW,Wabel P,Moissl UM,et al.A whole-body model to distinguish excess fluid from the hydration of major body tissues[J].Am J Clin Nutr,2007,85(1):80-89.
4 Agarwal R.Hypertension and survival in chronic hemodialysis patientpast lessons and future opportunities[J].Kidney Int,2005,67(1):1-13.
5 Bansal N,McCulloch CE,Lin F,et al.Blood Pressure and Risk of Cardiovascular Events in Patients on Chronic Hemodialysis:The CRIC Study(Chronic Renal Insufficiency Cohort)[J].Hypertension,2017,70(2):435-443.
6 Mark PB,Johnston N,Groenning BA,et al.Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging[J].Kidney Int,2006,69(10):1839-1845.
7 Messerli FH,Rimoldi SF,Bangalore S.The transition from hypertension to heart failure:contemporary update[J].JACC Heart Fail,2017,5(8):543-551.
8 Griffin KA,Polichnowski A,Litbarg N,et al.Critical blood pressure threshold dependence of hypertensive injury and repair in a malignant nephrosclerosis model[J].Hypertension,2014,64(4):801-807.
9王凌航,左力,王梅.生物电阻抗频谱法分析血液透析患者体液分布异常及其对血压的影响[J].中华肾脏病杂志,2005,21(2):85-87.
10刘婧,周亦伦,孙芳,等.小腿电阻抗比值评价透析患者容量对改善高血压的作用[J].中华肾脏病杂志,2011,27(7):499-503.
11 Liu L,Zhu F,G Raimann J,et al.Determination of fluid status in haemodialysis patients with whole body and calf bioimpedance techniques[J].Nephrology(Carlton),2012,17(2):131-140.
12 Agarwal R,Alborzi P,Satyan S,et al.Dry-Weight Reduction in Hypertensive Hemodialysis Patients(DRIP):a randomized,controlled trial[J].Hypertension,2009,53(3):500-507.
13 Chazot C,Wabel P,Chamney P,et al.Importance of normohydration for the long-term survival of haemodialysis patients[J].Nephrol Dial Transplant,2012,27(6):2404-2410.
14 Zoccali C.Left ventricular mass index as an outcome measure in clinical trials in dialysis patients:a word of caution[J].Am J Nephrol,2011,33(4):370-372.
15 Agarwal R,Bouldin JM,Light RP,et al.Probing dry weight improves left ventricular mass index[J].Am J Nephrol,2011,33(4):373-380.
16 Mohamed BA,Asif AR,Schnelle M,et al.Proteomic analysis of shortterm preload-induced eccentric cardiac hypertrophy[J].J Transl Med,2016,14(1):149.
17 Jing L,Binkley CM,Suever JD,et al.Cardiac remodeling and dysfunction in childhood obesity:a cardiovascular magnetic resonance study[J].J Cardiovasc Magn Reson,2016,18(1):28.
18 Ozkahya M,Ok E,Toz H,et al.Long-term survival rates in haemodialysis patients treated with strict volume control[J].Nephrol Dial Transplant,2006,21(12):3506-3513.
19 Hur E,Usta M,Toz H,et al.Effect of fluid management guided by bioimpedance spectroscopy on cardiovascular parameters in hemodialysis patients:a randomized controlled trial[J].Am J Kidney Dis,2013,61(6):957-965.
2 Zhu F,Kotanko P,Handelman GJ,et al.Estimation of normal hydration in dialysis patients using whole body and calf bioimpedance analysis[J].Physiol Meas,2011,32(7):887-902.
3 Chamney PW,Wabel P,Moissl UM,et al.A whole-body model to distinguish excess fluid from the hydration of major body tissues[J].Am J Clin Nutr,2007,85(1):80-89.
4 Agarwal R.Hypertension and survival in chronic hemodialysis patientpast lessons and future opportunities[J].Kidney Int,2005,67(1):1-13.
5 Bansal N,McCulloch CE,Lin F,et al.Blood Pressure and Risk of Cardiovascular Events in Patients on Chronic Hemodialysis:The CRIC Study(Chronic Renal Insufficiency Cohort)[J].Hypertension,2017,70(2):435-443.
6 Mark PB,Johnston N,Groenning BA,et al.Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging[J].Kidney Int,2006,69(10):1839-1845.
7 Messerli FH,Rimoldi SF,Bangalore S.The transition from hypertension to heart failure:contemporary update[J].JACC Heart Fail,2017,5(8):543-551.
8 Griffin KA,Polichnowski A,Litbarg N,et al.Critical blood pressure threshold dependence of hypertensive injury and repair in a malignant nephrosclerosis model[J].Hypertension,2014,64(4):801-807.
9王凌航,左力,王梅.生物电阻抗频谱法分析血液透析患者体液分布异常及其对血压的影响[J].中华肾脏病杂志,2005,21(2):85-87.
10刘婧,周亦伦,孙芳,等.小腿电阻抗比值评价透析患者容量对改善高血压的作用[J].中华肾脏病杂志,2011,27(7):499-503.
11 Liu L,Zhu F,G Raimann J,et al.Determination of fluid status in haemodialysis patients with whole body and calf bioimpedance techniques[J].Nephrology(Carlton),2012,17(2):131-140.
12 Agarwal R,Alborzi P,Satyan S,et al.Dry-Weight Reduction in Hypertensive Hemodialysis Patients(DRIP):a randomized,controlled trial[J].Hypertension,2009,53(3):500-507.
13 Chazot C,Wabel P,Chamney P,et al.Importance of normohydration for the long-term survival of haemodialysis patients[J].Nephrol Dial Transplant,2012,27(6):2404-2410.
14 Zoccali C.Left ventricular mass index as an outcome measure in clinical trials in dialysis patients:a word of caution[J].Am J Nephrol,2011,33(4):370-372.
15 Agarwal R,Bouldin JM,Light RP,et al.Probing dry weight improves left ventricular mass index[J].Am J Nephrol,2011,33(4):373-380.
16 Mohamed BA,Asif AR,Schnelle M,et al.Proteomic analysis of shortterm preload-induced eccentric cardiac hypertrophy[J].J Transl Med,2016,14(1):149.
17 Jing L,Binkley CM,Suever JD,et al.Cardiac remodeling and dysfunction in childhood obesity:a cardiovascular magnetic resonance study[J].J Cardiovasc Magn Reson,2016,18(1):28.
18 Ozkahya M,Ok E,Toz H,et al.Long-term survival rates in haemodialysis patients treated with strict volume control[J].Nephrol Dial Transplant,2006,21(12):3506-3513.
19 Hur E,Usta M,Toz H,et al.Effect of fluid management guided by bioimpedance spectroscopy on cardiovascular parameters in hemodialysis patients:a randomized controlled trial[J].Am J Kidney Dis,2013,61(6):957-965.