目的 分析颈动脉校正血流时间(FTc)在维持性血液透析(MHD)患者容量超负荷评估的临床应用价值. 方法 选取104例MHD患者作为研究对象,收集透析前后相关化验指标,超声测量FTc、心脏每搏量(SV)等指标,比较透析前后各项指标差异;多元线性回归分析单位体表面积FTc(UFTc)影响因素;以透析前血浆脑钠肽(BNP)水平分为容量超负荷和非容量超负荷两组,受试者工作特征(ROC)曲线分析UFTc对MHD患者容量超负荷的诊断价值. 结果 ①MHD患者透析后FTc为(292.71±29.82)ms,较透析前FTc[(345.56±24.01)ms]缩短,P<0.05,差异有统计学意义,且FTc变化量(△FTc)与脱水量(DHY)呈正相关(r=0.327,P<0.05);②多元线性回归分析显示UFTc受脉压差、lgBNP、尿素下降率(URR)等因素影响;③ROC曲线显示UFTc取截断值199.30 ms/m2时,诊断容量超负荷灵敏度为60%,特异度为81.1%,曲线下面积为0.706. 结论 FTc能够评估MHD患者血容量,UFTc可以为临床评估MHD患者容量超负荷及调整治疗方案提供参考.
Objective To evaluate the clinical value of carotid artery corrected flow time(FTc)in the assessment of volume overload in maintenance hemodialysis(MHD)patients.Methods 104 patients with MHD were selected as the study objects.Relevant laboratory indexes were collected before and after dialysis.FTc,stroke volume(SV)were measured by ultrasound.The influence factors of FTc per unit body surface area(UFTc)were analyzed by multiple linear regression.The plasma brain natriuretic peptide(BNP)levels were divided into volume overload and non-vol-ume overload groups.The diagnostic value of UFTc in MHD patients with volume overload was analyzed by receiver operating characteristic(ROC)curve.Results ①The FTc of MHD patients after dialysis(292.71±29.82)ms was shorter than that before dialysis(345.56±24.01)ms,P<0.05,the difference was statistically significant,and the change of FTc(△FTc)was positively correlated with the amount of dehydration(DHY)(r=0.327,P<0.05).②Multiple linear regression analysis showed that UFTc was affected by pulse pressure difference,lgBNP,urea decline rate(URR),etc.③ROC curve showed that when the cut-off value of UFTc was 199.30 ms/m2,the sensitivity of di-agnostic volume overload was 60%,the specificity was 81.1%,and the area under the curve was 0.706.Conclusions FTc can evaluate blood volume of MHD patients,UFTc can provide a reference for clinical evaluation of volume o-verload in patients with MHD and adjust treatment regimens.