摘要目的 分析探讨腹膜透析(peritoneal dialysis,PD)患者不同血压水平对预后的影响.方法 回顾性分析2008年1月1日至2017年6月30日在浙江大学附属第一医院肾脏病中心开始PD的终末期肾病患者6个月内居家血压水平,收集患者临床和预后资料,通过Cox比例风险模型和限制性立方样条图(restricted cubic spline)回归模型分析不同血压水平与PD患者全因死亡及心脑血管事件死亡之间的关系.结果 共1663例PD患者被纳入本研究,其中女性737例(44.3％),中位随访时间29.9个月,收缩压(SBP)和舒张压(DBP)分别为(135.2±15.8)mmHg和(83.1±10.5)mmHg.至随访终点,共221例(13.3％)患者死亡,其中心脑血管原因死亡102例,占46.2％.以130≤SBP<140 mmHg或80≤DBP<90 mmHg作为参照,SBP<120 mmHg(HR=2.05,95％CI 1.29～3.27,P=0.001)、SBP≥150 mmHg(HR=1.83,95％CI 1.19～2.82,P=0.005)、DBP≥90 mmHg(HR=1.80,95％CI 1.21～2.68,P=0.005)的PD患者全因死亡风险增高.PD患者SBP水平与患者全因死亡呈"U"形关系,DBP水平与患者全因死亡呈"J"形关系.结论 SBP水平过高、过低均会增加PD患者全因死亡风险,DBP过高亦会增加PD患者全因死亡风险,但无论SBP还是DBP都未观察到与心脑血管事件死亡风险有统计学意义上的关系,这个结果还有待多中心和前瞻性研究进一步证实.

abstractsObjective To investigate the association between the home blood pressure (BP) and morality in peritoneal dialysis (PD). Methods PD patients from the First Affiliated Hospital of Zhejiang University from January 1, 2008 to June 30, 2016 were studied. Over the first 6 months PD therapy, systolic SB (SBP) and diastolic BP (DBP) averaged as 5 (<120 to≥150 mmHg in 10 mmHg increments) and 4 (<70 to≥90 mmHg in 10 mmHg increments) categories, respectively, as well as continuous measures. All - cause and cardiovascular mortality were assessed by using Cox regression models adjusted for demographics, laboratory measurements, comorbid conditions and antihypertensive medications. The relationships between home BP and all - cause and cardiovascular mortality were assessed by restricted cubic spline regression model. Results A total of 1663 PD patients were included with a median follow-up of 29.9 months, in which 737 patients (44.3％) were female. The SBP and DBP were (135.2±15.8) mmHg and (83.1±10.5) mmHg, respectively. Two hundred and twenty-one PD patients died during the study period, of which 102 patients (46.2％) died of cardiac - cerebral vascular events. With 130≤SBP<140 mmHg as a refernece, SBP≥150 mmHg (HR=1.83, 95％CI 1.19-2.82, P=0.005) and SBP<120 mmHg (HR=2.05, 95％CI 1.29-3.27, P<0.001) were associated with significantly higher risks of all-cause morality, but not cardiovascular morality. With 80≤DBP< 90 mmHg as a refernece, patients with DBP≥90 mmHg exhibited significantly higher risks of all-cause mortality (HR=1.80, 95％CI 1.21-2.68, P=0.009). SBP presented a U-shaped association with all-cause mortality. DBP presented a J-shaped association with all-cause mortality. Conclusions Higher SBP, lower SBP and higher DBP are associated with higher risks of all - cause mortality in PD patients. However, neither SBP nor DBP is observed statistically significant relationship with the risk of cardiovascular mortality. Further prospective and randomized clinical trials are needed to determine the optimal BP targets and improve the management of hypertension in PD patients.