维持性血液透析患者不同血管通路类型的临床特征及全因死亡差异比较

doi:10.3969/j.issn.1671-4091.2021.06.003

摘要/Abstract

摘要： 【摘要】目的比较不同血管通路类型的维持性血液透析(maintenance hemodialysis,MHD)患者的临床特征及全因死亡差异。方法回顾性收集2010 年5 月31 日～2016 年12 月31 日于大连大学附属中山医院开始接受长期MHD 患者310 例，随访截止时间为2020 年7 月31 日，随访终点为全因死亡、血管通路并发症事件和新发心脑血管事件。比较自体动静脉内瘘组(autologous arteriovenous fistula，AVF)和带隧道和涤纶套的透析导管组(tunnel-cuffed catheter，TCC)患者的临床资料、实验室指标、心脏超声参数及全因死亡差异。结果共纳入310 例MHD 患者，男性184 例(59.4%)，年龄(65.69±13.11)岁。2 组患者开始透析年龄及原发病构成比较，差异有统计学意义(t=-3.134，P=0.002；χ2=11.792，P=0.007)。TCC 组肾性贫血发生率高于AVF 组(χ2=5.120，P=0.024)，AVF 组肺动脉高压(pulmonary arterial hypertension，PAH)发生率高于TCC 组(χ2=4.696，P=0.030)；经过50.00(25.00,73.25)月随访，219 例患者死
亡，男性(HR=1.384, 95% CI:1.042～1.839, P=0.025)、开始透析年龄(HR=1.036,95% CI:1.023～1.049, P=0.001)、心血管疾病史(HR=1.698, 95% CI:1.244～2.318, P=0.001)、使用TCC 血液透析(HR=2.264, 95% CI:1.703～3.009, P=0.001)、糖尿病肾病(HR= 1.734, 95%CI:1.322～2.275,P=0.001)是MHD 患者全因死亡的独立危险因素。结论AVF 组肺动脉高压发生率更高，TCC 组肾性贫血发生率较高，使用TCC 透析、开始透析年龄、既往心血管疾病史、原发病糖尿病肾病是MHD 患者全因死亡的独立危险因素。

关键词: 维持性血液透析, 血管通路, 肺动脉高压, 全因死亡

Abstract: 【Abstract】Objective To compare the clinical characteristics and all-cause mortality of maintenance hemodialysis (MHD) patients with different vascular access types. Methods A retrospective collection of 310 MHD patients started receiving MHD in affiliated Zhongshan Hospital of Dalian University from May 31, 2010 to December 31, 2016. The follow-up deadline was July 31, 2020. The endpoint events were all-cause death, complications of vascular access, and cardiovascular and cerebrovascular events. The differences in clinical data, laboratory indexes, cardiac ultrasound parameters, and all-cause mortality rate of patients in the
autogenous arteriovenous fistula (AVF) group and the tunnel- cuffed catheter (TCC) group were compared. Results A total of 310 MHD patients were enrolled, with 184 males (59.4%), and the mean age was 65.69±13.11 years old. The age of starting dialysis and the primary cause of end-stage renal disease were different between groups (t=- 3.134, P=0.002;χ2=11.792, P=0.007). Compare with the AVF group, patients in the TCC group with a higher rate of anemia (χ2=5.120，P=0.024) and a lower rate of pulmonary hypertension (χ2=4.696, P=0.030). The incidence of pathway complications and cardiovascular death was not statistically significant (P>0.05). After 50.00 (25.00, 73.25) months of follow-up, 219 patients died. The independent risk factors of
all-cause death including male gender (HR=1.384, 95% CI:1.042～1.839, P=0.025), the age of starting dialysis (HR=1.036, 95% CI: 1.023～1.049, P=0.001), the history of cardiovascular disease (HR=1.698, 95% CI: 1.244～2.318, P=0.001), use catheter (HR= 2.264, 95% CI:1.703～3.009, P=0.001), diabetic nephropathy (HR=1.734, 95% CI:1.322～2.275, P=0.001). Conclusion Patients in the TCC group with a higher rate of anemia and a lower rate of pulmonary hypertension. Use catheter, the age of starting dialysis, history of cardiovascular disease, and diabetic nephropathy were independent risk factors of all-cause death in our MHD patients.

Key words: Maintenance hemodialysis, Vascular access, Pulmonary hypertension, All-cause death

中图分类号:

R318.16

屈斌, 张倩, 高弼虎. 维持性血液透析患者不同血管通路类型的临床特征及全因死亡差异比较[J]. 中国血液净化, 2021, 20(06): 367-372.

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