Wang M C, Tseng C C, Tsai W C, Huang J J
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China.
Perit Dial Int. 2001 Jan-Feb;21(1):36-42.
To examine the relation between the results of ambulatory 24-hour blood pressure monitoring (ABPM) and left ventricular mass index (LVMI), then to find the independent determinant for left ventricular hypertrophy (LVH) in peritoneal dialysis (PD) patients. Finally, to evaluate the differences in the clinical and cardiovascular characteristics between patients on continuous ambulatory PD (CAPD) and continuous cyclic PD (CCPD).
An open, nonrandomized, cross-sectional study.
Divisions of nephrology and cardiology in a medical center.
Thirty-two uremic patients on maintenance PD therapy (22 patients on CAPD, and 10 on CCPD) without anatomical heart disease or history of receiving long-term hemodialysis.
Home blood pressure (BP) and office BP were measured using the Korotkoff sound technique by sphygmomanometer. ABPM was employed for continuous measurement of BP. Echocardiography was performed for measurement of cardiac parameters and calculation of LVMI.
Multivariate logistic regression analysis was performed for independent determinant of LVH in PD patients. The differences in clinical and cardiovascular characteristics between CAPD and CCPD patients were compared.
Simple regression analysis showed positive correlations between LVMI and the duration of hypertension, ambulatory nighttime BP/BP load/BP load > 30%, serum phosphate, calcium-phosphate product, ultrafiltration (UF) volume, and percentage of UF volume during the nighttime. A negative correlation was noted between LVMI and dipping. In multiple regression analysis, the duration of hypertension was the only variable linked to LVMI. In multivariate logistic regression analysis, only ambulatory nighttime systolic BP load > 30% had an independent association with LVH. There were correlations between office/home BP and ambulatory 24-hour BP. In addition, CCPD patients had higher LVMI, UF volume during the nighttime, and percentage of UF volume during the nighttime than those of CAPD patients.
In this study, ambulatory nighttime systolic BP load > 30% had an independent association with LVH. Office and home BP measurements were correlated with ABPM in PD patients. The result that CCPD patients had a higher LVMI than CAPD patients may be due to a relative volume overload during the daytime in CCPD patients.
探讨动态24小时血压监测（ABPM）结果与左心室质量指数（LVMI）之间的关系，进而找出腹膜透析（PD）患者左心室肥厚（LVH）的独立决定因素。最后，评估持续非卧床腹膜透析（CAPD）患者与持续循环腹膜透析（CCPD）患者在临床和心血管特征方面的差异。
一项开放、非随机的横断面研究。
某医疗中心的肾病科和心内科。
32例接受维持性PD治疗的尿毒症患者（22例接受CAPD治疗，10例接受CCPD治疗），无心脏解剖学疾病或长期血液透析史。
使用血压计通过柯氏音技术测量家庭血压（BP）和诊室血压。采用ABPM持续测量血压。进行超声心动图检查以测量心脏参数并计算LVMI。
对PD患者LVH的独立决定因素进行多因素逻辑回归分析。比较CAPD和CCPD患者在临床和心血管特征方面的差异。
简单回归分析显示LVMI与高血压病程、动态夜间血压/血压负荷/血压负荷>30%、血清磷酸盐、钙磷乘积、超滤（UF）量以及夜间UF量百分比呈正相关。LVMI与血压下降呈负相关。在多元回归分析中，高血压病程是与LVMI相关的唯一变量。在多因素逻辑回归分析中，仅动态夜间收缩压负荷>30%与LVH存在独立关联。诊室/家庭血压与动态24小时血压之间存在相关性。此外，CCPD患者的LVMI、夜间UF量以及夜间UF量百分比均高于CAPD患者。
在本研究中，动态夜间收缩压负荷>30%与LVH存在独立关联。PD患者的诊室和家庭血压测量值与ABPM相关。CCPD患者的LVMI高于CAPD患者，这一结果可能是由于CCPD患者白天存在相对容量超负荷。
