高海拔地区维持性血液透析间期患者代谢性酸中毒的发生及不良结局

Incidence and Adverse Outcome of Metabolic Acidosis in Maintenance Hemodialysis Patients at High Altitude

摘要: 目的：探索高海拔地区维持性血液透析(MHD)间期患者代谢性酸中毒(MA)的发生及不良结局。方法：选取青海大学附属医院肾病内科血透室的MHD患者67例，于透析间期对患者进行动脉血气分析及常规实验室检测。根据患者的碳酸氢根HCO₃^-值将患者分为MA组(HCO₃^-≤ 21 mmol/L)和非MA组(HCO₃^-> 21 mmol/L)，收集患者的一般资料和临床资料，比较两组一般资料、临床资料和实验室指标的差异，探讨MA的发生及不良结局。符合正态分布的计量资料用(X±s)表示，组间比较采用t检验；计量资料为非正态分布的用中位数和四分位数间距表示，组间比较采用秩和检验；危险因素分析采用Logistic回归分析。结果：两组的抽烟比例、饮酒比例、合并心血管疾病比例、不饱和铁结合力UIBC、血钾K、血尿素氮BUN、发生消化道不适比例、发生心律失常比例、红细胞计数RBC、红细胞压积HCT、血红蛋白HB、血清白蛋白ALB的P < 0.05，存在统计学差异，回归分析提示抽烟比例、饮酒比例、合并心血管疾病比例、不饱和铁结合力UIBC的P < 0.05，存在统计学差异。结论：高海拔地区MHD间期发生MA比平原地区更常见，其抽烟、饮酒比例的升高、合并心血管疾病比例的增加、UIBC的降低是发生MA的危险因素，BUN、K的升高加重了MHD间期MA的发生，而MA可能参与了患者营养不良、心律失常及消化道症状的发生，其中MA患者在缺氧环境下一定程度上可能导致了代偿性红细胞增多。

Abstract: Objective: To explore the incidence and adverse outcomes of metabolic acidosis (MA) in maintenance hemodialysis (MHD) patients at high altitude. Methods: Sixty-seven MHD patients were selected from the hemodialysis room of Department of Nephrology, The Affiliated Hospital of Qinghai University. Patients were divided into MA group (HCO₃^-≤ 21 mmol/L) and non-MA group (HCO₃^-> 21 mmol/L) according to their bicarbonate HCO₃^- values. The general data and clinical data of patients were collected, and the differences of general data, clinical data and laboratory indexes between the two groups were compared to discuss the occurrence and adverse outcomes of MA. The measurement data conforming to normal distribution is expressed by (X±s), and the comparison between groups adopts t test. The data with non-normal distribution are expressed by median and interquartile distance, and rank sum test is used for comparison between groups. Risk factors were analyzed by Logistic regression analysis. Results: P values of the smoking ratio, drinking ratio, combined cardiovascular disease ratio, unsaturated iron binding capacity UIBC, blood potassium K, blood urea nitrogen BUN, digestive tract discomfort ratio, arrhythmia ratio, red cell count RBC, hematocrit HCT, hemoglobin HB, serum albumin ALB of the two groups were <0.05, and there were statistical differences. Regression analysis showed that there were statistical differences in the proportion of smoking, drinking, cardiovascular diseases and unsaturated iron binding force UIBC (P < 0.05). Conclusion: The occurrence of MA during MHD interval in high altitude areas is more common than that in plain areas. The increase of smoking and drinking, the increase of cardiovascular diseases and the decrease of UIBC are the risk factors of MA. The increase of BUN and K aggravates the occurrence of MA during MHD interval, and MA may be involved in the occurrence of malnutrition, arrhythmia and digestive tract symptoms, among which MA patients under the hypoxia environment may lead to compensatory polycythemia to a certain extent.