中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (10): 573-575.doi: 10.3969/j.issn.1671-4091.2016.10.015

• 血管通路 • 上一篇    下一篇

糖尿病对动静脉内瘘成熟影响的临床研究

王春丽,杨涛,张丽红,王玉柱   

  1. 北京市海淀医院肾内科
  • 收稿日期:2016-05-16 修回日期:2016-08-15 出版日期:2016-10-12 发布日期:2016-10-10
  • 通讯作者: 王玉柱 wclzq222@sina.cn E-mail:wyz4417@sina.com

Clinical investigation on the effect of diabetes on maturation of arteriovenous fistula

  • Received:2016-05-16 Revised:2016-08-15 Online:2016-10-12 Published:2016-10-10

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摘要： 目的探讨糖尿病对终末期肾病(end Stage Renal Disease,ESRD)患者动静脉内瘘(arteriovenous Fistula，AVF)术后3 个月时成熟的影响。方法选择北京市海淀医院就诊的ESRD 患者，按照是否合并糖尿病分组，综合评估后确定手术方案并建立AVF。术后3 个月应用超声复查内瘘，结合物理检查判断AVF 成熟情况。结果研究共纳入118 例患者，观察组AVF 成熟率明显低于对照组,差异有统计学意义(72.0% 比95.6%，χ2=13.001, P＜0.001)；观察组血管钙化发生率明显高于对照组，差异有统计学意义(χ2=5.002，P=0.025)；单因素Logistic 回归分析显示，糖尿病(OR 8.426,95% CI 2.270～31.283,P=0.001)和桡动脉内径＜1.5mm(OR 6.257，95% CI 2.020～19.381,P=0.001)影响AVF 成熟，差异有统计学意义；多因素二元Logistic 回归分析显示，糖尿病(OR 9.086，95% CI 2.302～35.866,P=0.002)和桡动脉内径＜1.5mm(OR 6.789，95% CI 2.022,P=0.002)是AVF 不成熟率增加的独立危险因素。结论糖尿病和桡动脉内径＜1.5mm 影响AVF 成熟，是AVF 不成熟率增加的独立危险因素。

关键词: 动静脉内瘘, 糖尿病, 血液透析

Abstract: Objective To investigate whether diabetes mellitus affects the maturation of autologous arteriovenous fistula (AVF) after the operation for 3 months in patients with end stage renal disease (ESRD). Methods We selected patients with ESRD in the Nephrology Department of Beijing Haidian Hospital, divided them into diabetes group and non-diabetes group, collected their general information, primary disease and vascular calcification to decide the operation plan after comprehensive evaluation, and record the corresponding parameters for vessel anastomosis before AVF operation. After the operation for 3 months, fistulas were examined by ultrasound, and the related parameters were recorded. The maturation of AVF was determined by physical and ultrasound examinations. Results This study included 118 patients. The maturation rate was significantly lower in diabetes group than in non-diabetes group (72.0% vs. 95.6%, c2= 13.001, P=0.000). The prevalence of vascular calcification was significantly higher in diabetes group than in non-diabetes group (c2= 5.002, P=0.025).Univariate logistic regression analysis showed that diabetes (OR 8.426, 95% CI 2.270～ 31.283, P=0.001) and radial artery diameter <1.5mm (OR 6.257, 95% CI 2.020～19.381, P=0.001) affected the maturation of AVF (P<0.05). Binary logistic regression analysis showed diabetes (OR 9.086, 95% CI 2.302～35.866, P=0.002) and radial artery diameter <1.5mm (OR 6.789, 95% CI 2.022, P=0.002) were the independent risk factors for delayed maturation of AVF. Conclusions The prevalence of vascular calcification and delayed maturation of AVF are relatively high in patients with diabetes. Diabetes and radial artery diameter<1.5mm are the independent risk factors for delayed maturation of AVF.

Key words: Arteriovenous fistula, Diabetes, Hemodialysis