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透析期间血压变化与心脑血管事件之间的关联

Association Between Blood Pressure Variation During Dialysis and Cardio-Cerebrovascular Events.

作者信息

Fan Zhenliang, Ye Rujia, Yang Qiaorui, Yang Mengfan, Yin Riping, Zhao Dongxue, Fan Junfen, Ma Hongzhen, Shen Yiwei, Xia Hong, Jiang Wenze, Lu Keda

机构信息

Nephrology Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.

Academy of Chinese Medical Science, Zhejiang Chinese Medical University, Hangzhou, China.

出版信息

J Clin Hypertens (Greenwich). 2025 Jan;27(1):e14934. doi: 10.1111/jch.14934. Epub 2024 Dec 10.

Abstract

In hemodialysis patients, blood pressure variability (BPV) is associated with cardiovascular events and all-cause mortality. However, previous research has predominantly concentrated on the predialysis BPV. In contrast, intradialytic BPV, reflecting the cardiovascular regulatory function during the process of rapid clearance of volume overload, holds greater relevance to the prognosis of patients. In this study, a latent category trajectory model was used to identify the patterns of intradialytic BPV and analyze the association between intradialytic BPV and the cardio-cerebrovascular events and other clinical outcomes. We found the variation of intradialytic systolic blood pressure (SBP) was associated with the risk of cardio-cerebrovascular events in hemodialysis patients. Patients in "SBP Class 4" and "SBP Class 3" subgroups were associated with the occurrence of cardio-cerebrovascular events and the number of cardio-cerebrovascular event hospitalizations during the follow-up period. This indicates that the variation pattern of intradialytic SBP results from the comprehensive action of various BP regulatory mechanisms in the body, which can reflect the level of cardiovascular regulatory function in hemodialysis patients and serve as a predictor of recent adverse cardio-cerebrovascular events.

摘要

在血液透析患者中,血压变异性(BPV)与心血管事件和全因死亡率相关。然而,以往的研究主要集中在透析前的BPV。相比之下,透析中BPV反映了在快速清除容量超负荷过程中的心血管调节功能,与患者的预后更相关。在本研究中,使用潜在类别轨迹模型来识别透析中BPV的模式,并分析透析中BPV与心脑血管事件及其他临床结局之间的关联。我们发现,血液透析患者透析中收缩压(SBP)的变化与心脑血管事件风险相关。“SBP 4级”和“SBP 3级”亚组的患者与随访期间心脑血管事件的发生以及心脑血管事件住院次数相关。这表明,透析中SBP的变化模式是机体各种血压调节机制综合作用的结果,能够反映血液透析患者的心血管调节功能水平,并可作为近期不良心脑血管事件的预测指标。

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