中心动脉压关键指标与慢性肾脏病进展至透析的关系探讨

On the Relationship between Key Indexes of Central Arterial Pressure and Progression of Chronic Kidney Disease to Dialysis

摘要: 目的：探讨中心动脉压关键指标是否与慢性肾脏病进展至透析有关。方法：本研究为回顾性队列研究，选取2017年2月至2019年10月在浙江省人民医院肾脏病科接受无创中心动脉压测量，且符合研究纳入及排除标准的306例慢性肾脏病住院患者为研究对象，研究终点为接受透析治疗，随访时间截止至2022年2月。从电子病历系统中检索患者的一般信息、实验室指标、中心动脉血压各个参数，其中中心动脉收缩压(CSBP)和中心动脉脉压(CPP)作为关键指标。根据基线CSBP和CPP水平四分位数，分别将研究对象分为Q1，Q2，Q3和Q4组，分别绘制CSBP和CPP的Kaplan-Meier曲线，建立Cox比例风险回归模型以探索CSBP和CPP是否为慢性肾脏病进展至透析的独立危险因素。结果：共纳入306例患者，随访时间为1061 (911, 1458)天。截止至随访结束，共有50例进入透析。在CSBP分组中，Q1至Q4组进展至透析的发生率依次为5.5%、13.6%、16.7%、29.7%；在CPP分组中，Q1至Q4组进展至透析的发生率分别为3.7%、17.1%、14.3%、33.8%，组间比较差异有统计学意义(p < 0.001)。Cox回归分析结果显示，与低水平的Q1组相比，CSBP高水平Q4组进入透析的风险比(HR)在模型1 (未校正模型)、模型2和模型3中分别为6.65 (2.29~19.35)，5.46 (1.83~16.26)，3.30 (1.01~10.75)。Kaplan-Meier曲线分析显示，CSBP四组间的肾脏累积生存率差异有统计学意义(p < 0.001)。类似的，与低水平的Q1组相比，CPP高水平Q4组在进入透析的风险比(HR)在模型1 (未校正模型)、模型2和模型3中分别为11.22 (3.35~37.62)，10.47 (2.91~37.67)，3.75 (1.07~13.12)。Kaplan-Meier曲线分析显示，CPP四组间的肾脏累积生存率差异有统计学意义(p < 0.001)。结论：高水平的中心动脉收缩压(CSBP)和中心动脉脉压(CPP)与慢性肾脏病进展至透析风险增加独立相关，可能是早期识别慢性肾脏病进展至透析的无创标记物。

Abstract: Objective: To investigate whether the key index of central arterial pressure is related to the progression of chronic kidney disease to dialysis. Methods: This study was a retrospective cohort study. 306 inpatients with chronic kidney disease who received noninvasive central arterial pressure measurement at the Department of Nephrology, Zhejiang Provincial People’s Hospital from February 2017 to October 2019 and met the inclusion and exclusion criteria were selected as the study subjects. The study endpoint was dialysis treatment, and the follow-up period ended in February 2022. The general information, laboratory indicators and central arterial blood pressure parameters were retrieved from the electronic medical record system, among which the central arterial systolic blood pressure (CSBP) and central arterial blood pressure (CPP) were the key indicators. According to the baseline quartile of CSBP and CPP levels, the subjects were divided into Q1, Q2, Q3 and Q4 groups, respectively. Kaplan-Meier curves of CSBP and CPP were plotted respectively, and Cox proportional risk regression model was established to explore whether CSBP and CPP were independent risk factors for progression to dialysis. Results: A total of 306 patients were included and followed up for 1061 (911, 1458) days. Up to the end of follow-up, a total of 50 patients entered dialysis. In the CSBP group, the incidence of progression to dialysis in groups Q1 to Q4 was 5.5%, 13.6%, 16.7% and 29.7%, respectively. In the CPP group, the incidence of progression to dialysis in groups Q1 to Q4 was 3.7%, 17.1%, 14.3% and 33.8%, respectively, with statistical significance (p < 0.001). Cox regression analysis showed that compared with the low Q1 group, the risk ratio (HR) of patients with high CSBP Q4 group entering dialysis was 6.65 (2.29~19.35) in model 1 (uncorrected model), 5.46 (1.83~16.26) and 3.30 (1.01~10.75) in model 2 and model 3, respectively. Kaplan-Meier curve analysis showed that there was a statistically significant difference in renal cumulative survival among the four CSBP groups (p < 0.001). Similarly, compared with the low Q1 group, the risk ratio (HR) for entering dialysis in the high CPP Q4 group was 11.22 (3.35~37.62), 10.47 (2.91~37.67), and 3.75 (1.07~13.12) in model 1 (uncorrected model), model 2, and model 3, respectively. Kaplan-Meier curve analysis showed that the difference in renal cumulative survival among the four CPP groups was statistically significant (p < 0.001). Conclusion: High levels of central arterial systolic blood pressure (CSBP) and central pulse pressure (CPP) were independently associated with an increased risk of progression of chronic kidney disease to dialysis and may be noninvasive markers for early identification of progression of chronic kidney disease to dialysis.