维持性血液透析患者透析充分性的影响因素分析

目的 采用生物电阻抗法（bioelectrical impedance analysis，BIA）探讨影响维持性血液透析（maintenance hemodialysis，MHD）患者透析充分性的人体成分、营养因素以及影响程度。方法 选取2017年11月 - 2019年5月在四川某三甲医院血液透析中心进行MHD的140例患者，收集患者一般情况、体成分和血液检查指标，并以尿素氮清除率（the urea clearance index，Kt/V）作为透析充分性的评价指标。根据Kt/V的结果分为透析充分组（Kt/V≥1.2）与透析不充分组（Kt/V＜1.2），将可能影响透析充分性的人体成分因素与营养指标纳入多元逐步回归分析，确定影响MHD患者透析充分性的因素。结果 透析充分组的男性构成比（χ2 = 7.265，P = 0.007）、白蛋白（t = 4.235，P＜0.001）、相位角（t = 3.974，P＜0.001）均高于透析不充分组，细胞内水分（t = - 3.476，P = 0.001）、细胞外水分（t = - 4.753，P＜0.001）、细胞总水分（t = - 4.186，P＜0.001）、细胞外水分/细胞总水分（Z = - 4.307，P＜0.001）、去脂体重（t = - 4.076，P＜0.001）、身体质量指数（t = - 3.861，P＜0.001）、身体细胞量（t = - 3.367，P = 0.001）、骨矿物质含量（t = - 4.035，P＜0.001）、肌肉减少构成比（χ2 = 7.875，P = 0.005）均低于透析不充分组。logistic回归分析结果显示，白蛋白（OR = 0.886，95%CI:(0.803～0.977)，P = 0.016）、细胞外水分/细胞总水分（OR = 2.386,95%CI:1.932～2.948,P = 0.001）、身体质量指数（OR = 1.197，95%CI:(1.031～1.389)，P = 0.019）、身体细胞量（OR = 1.154，95%CI:1.054～1.264，P = 0.002）为透析充分性的独立影响因素。结论 白蛋白、身体质量指数、身体细胞量、细胞外水分/细胞总水分影响血液透析患者透析充分性，定期监测人体成分与营养状况，提高营养状况，有助于达到透析充分性，保障血液透析治疗效果，提高患者的生存质量。

Analysis of influencing factors of dialysis sufficiency in sustained hemodialysis patients

To study the influencing factors of hemodialysis sufficiency in maintenance hemodialysis(MHD) patients by bioelectrical impedance analysis(BIA). Methods A total of 140 MHD patients in a hospital hemodialysis center from November2017 to May 2019 were enrolled as the study subjects. Their general information, postdialysis body composition and blood test results were collected. According to the results of Kt/V, the patients were divided into the sufficient dialysis group(Kt/V≥1.2) and the insufficient dialysis group(Kt/V<1.2). A multiple stepwise regression analysis was conducted to determine the factors that potentially affect the dialysis sufficiency in MHD patients. Results The constituent ratio of Male(χ2=7.265, P=0.007), albumin(t=4.235, P<0.001) and phase angle(t=3.974, P<0.001) in the sufficient dialysis group were all higher than those in the insufficient dialysis group. The intracellular water(t=-3.476, P=0.001), the extracellular water(t=-4.753,P<0.001), total body water(t=-4.186,P<0.001), the extracellular water/total body water(Z=-4.307, P<0.001), fat free mass(t=-4.076, P<0.001), body mass index(t=-3.861, P<0.001), body cell mass(t=-3.367,P=0.001), bone mineral content(t=-4.035, P<0.001) and the constituent ratios of muscle loss(χ2=7.875, P=0.005) were all lower than those in the insufficient dialysis group.The result of Logistic regression analysis showed that albumin OR=0.886, 95%CI:(0.803, 0.977), P=0.016], the extracellular water/total body water OR=2.386, 95%CI:(1.932, 2.948), P=0.001], body mass index OR=1.197, 95%CI:(1.031, 1.389), P=0.019] and body cell mass OR=1.154, 95%CI:(1.054, 1.264), P=0.002] were independent influencing factors of dialysis sufficiency. Conclusion The albumin, the extracellular water/total body water, body mass index and body cell mass can be used to evaluate the dialysis sufficiency in MHD patients.Regular monitoring of human body components and nutritional status can help improve the nutritional status and sufficiency of dialysis, ensure the therapeutic effect of hemodialysis, and improve the quality of life of MHD patients.