新容量超负荷指标overhydration在腹膜透析患者中的临床价值

目的 评价overhydration（OH）作为新的容量超负荷无创指标在腹膜透析（腹透）患者中的应用价值。 方法 选择2009年1月至6月复诊于北京大学第三医院腹透中心的80例持续性非卧床腹透患者，应用生物电阻抗技术连续测定OH值6个月，在末次进行OH测定时，行超声心动图（UCG）检查。将OH值与UCG判断容量超负荷的心脏间接指标、长期容量超负荷状态下心脏结构改变的相关指标进行线性回归和相关分析。再按OH值将患者分为两组：OH＜2 L组（容量正常组）及OH≥2 L组（容量超负荷组），比较两组间心脏形态结构、功能、血流动力学的差异。 结果 相关分析显示，80例腹透患者OH值与左室舒张末容积（EDV）、左室收缩末容积（ESV）、左室舒张末内径（LVEDD）、左房内径（LA）、左室质量（LVM）、体表面积标化左室质量指数（LVMIBSA）、身高标化LVMI（LVMI身高）均呈正相关（均P ＜ 0.01），校正相关系数分别为0.21、0.27、0.14、0.12、0.26、0.25、0.20。两组间性别、年龄、身高、体质量、体质量指数（BMI）、尿素清除指数（Kt/V）差异均无统计学意义。OH≥2 L组OH、收缩压（SBP）、舒张压（DBP）、脉压（PP）、平均动脉压（MAP）均显著大于OH＜2 L组（均P ＜ 0.01）。两组间心脏收缩功能指标及舒张功能指标差异无统计学意义。OH≥2 L组的心脏结构形态指标和血流动力学指标均显著高于OH＜2 L组（P ＜ 0.01或P ＜ 0.05）。OH≥2 L组ESV高于OH＜2 L组，但差异无统计学意义（P = 0.08）。两组间总外周阻力（TPR）、总外周阻力指数（TPRI）差异无统计学意义。OH≥2 L组左室后壁舒张期厚度（LVPW）、室间隔舒张期厚度（IVS）、LVM、LVMIBSA、LVMI身高、左室肥厚（体表面积标化）（LVHBSA）和LVH身高均高于OH＜2 L组（P ＜ 0.01或P ＜ 0.05）。 结论 腹透患者OH与UCG指标显著相关，且OH值升高对心血管状况的影响与临床容量超负荷状态下的心脏形态、结构、血流动力学的改变相一致，因此，OH作为新的容量超负荷评价指标在腹透患者中有很好的应用价值。

Clinic value of a novel marker overhydration in peritoneal dialysis patients

Objective To evaluate the clinical value of a new non-invasive and quantitative index overhydration(OH)in hydration status assessment for peritoneal dialysis(PD)patients.Methods Eighty peritoneal dialysis patients were enrolled in this study.Overhydration was measured by electrical bioimpedance measurement.Echocardiography was also performed at the same time.Linear regression and correlation analysis were carried out between OH and echocardiographic indicators.Cardiac status of patients with high-OH(OH≥2 L)and low-OH (OH ＜2 L)value was also compared.Results In these 80 PD patients,OH was positively eorrelated with EDV,ESV,LVEDD,LA,LVM,LVMI_(BSA),LVMI_(height)(all P＜0.01).The adjusted RR was 0.21,0.27,0.14,0.12,0.26,0.25 and 0.20,respeetively.There were no significant differences in gender,age,height,weight,dialysis duration,BMI,Kt/V between high-OH and lowOH patients.The SBP,DBP,PP,MAP were high in high-OH group as compared to low-OH group (P＜0.01).LVEF,LVFS,SV,CO,CI,E peak,A peak,E/A did not differ between two groups.Cardiac structure and hemodynamic parameters,such as ESV,LVEDD,RV,LA,VTI,AV max,were higher in high-Oil group as compared to low-OH group(P＜0.05),while no significant difference of TPR and TPRI between two groups was found.Left ventricular remodeling indicators,such as IVS,LVPW,LVM,LVMI_(BSA),LVMI_(height),LVH_(BSA) and LVH_(height),were higher in high-OH group than those in low-OH group(P＜0.05).Conclusion OH as a novel marker in hydration status assessment is closely correlated with cardiac structure,which may be used as a non-invasive quantitative indicator of fluid status in PD patients.