维持性血液透析患者容量状况的评估
Assessment of volume status in maintenance hemodialysis patients

目的 ·评估维持性血液透析（ maintenance hemodialysis，MHD）患者的容量状况。方法 ·对 128例上海交通大学医学院附属仁济医院的 MHD患者进行人体成分分析，并结合血液透析前收缩压（ predialysis systolic blood pressure，preBPsys）、水肿情况、脑钠肽（brain natriuretic peptide，BNP）进行容量评估。根据容量状况（ hydration status，HS）相对百分比（ HS%）将患者分为容量过多组（HS%>15%）和容量正常组（ HS% ≤ 15%）。比较 2组人体成分，如瘦组织指数（ LTI）、脂肪组织指数（ FTI）；比较血压、水肿情况、 BNP、血钙、血磷、甲状旁腺激素（ iPTH）、血红蛋白、血清白蛋白、前白蛋白、超敏 C反应蛋白（ hs-CRP）、血清钠及尿素清除指标（ Kt/V）。结果 · 69例患者血液透析前容量和血压均达标； 10例患者容量和血压均过高； 18例患者容量超标，但血压不高。与容量正常组比较，容量过多组患者水肿更明显， BNP较高， LTI值、白蛋白和前白蛋白较低，血钠水平较高，差异均有统计学意义（P<0.05）。结论 ·将血压、水肿情况、实验室指标与采用生物电阻抗技术的人体成分分析结果结合，可以更客观、更准确地评估血液透析患者的容量状况。容量过多的患者伴随高血钠、低白蛋白、低血红蛋白、瘦组织减少的发生；控制钠盐摄入、改善营养状况和纠正贫血可能有助于减轻容量超负荷。
：Objective · To assess volume status in maintenance hemodialysis (MHD) patients. Methods · Body composition analysis was performed on 128 MHD patients Renji Hospital, Shanghai Jiao Tong University School of Medicine. The volume status was assessed based on body composition data and predialysis systolic blood pressure (preBPsys), edema grade, brain natriuretic peptide (BNP). Patients were divided into hyperhydrated group (percentage of hydration status, HS%>15%) or normohydrated group (HS% ≤15%). Body composition data were compared, including lean tissue index (LTI) and fat tissue index (FTI). The blood pressure, edema grade, serum calcium, serum phosphate, intact parathyroid hormone (iPTH), hemoglobin, albumin, pre-albumin, hypersensitive C-reactive protein (hs-CRP), serum sodium, and urea clearance Kt/V were compared between two groups. Results · Sixty-nine patients were normohydrated and preBPsys reached target; 10 patients were overhydrated with higher preBPsys; 18 patients had overhydration but preBPsys was in target range. Compared to normohydraed group, patients in hyperhydrated group had more obvious edema, higher BNP level, significantly lower LTI, serum albumin and pre-albumin levels, while serum sodium was significantly higher (P<0.05). Conclusion · Volume status of hemodialysis patients can be objectively and accurately assessedbody composition analysis using bioimpedance technique with blood pressure, edema grade and biochemical parameters. Hyperhydrated patients may have higher serum sodium level, lower serum albumin, lower hemoglobin, and less lean tissue mass concomitantly. Sodium intake control, nutrition status improvement, and anemia correction may be useful to reduce hyperhydration