中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (01): 51-54.doi: 10.3969/j.issn.1671-4091.2022.01.012

• 血管通路 • 上一篇    下一篇

心脏瓣膜钙化与维持性血液透析患者自体动静脉内瘘失功的相关性分析

赵彬1,詹申1,侯方1,张丽红1,王玉柱1   

  1. 1北京市海淀医院肾内科
  • 收稿日期:2021-08-10 修回日期:2021-10-13 出版日期:2022-01-12 发布日期:2022-01-04
  • 通讯作者: 王玉柱 wyz4417@126.com E-mail:wyz4417@126.com

Relationship between cardiac valve calcification and arteriovenous fistula dysfunction in maintenance hemodialysis patients

  1. 1Department of nephrology, Haidian Hospital, Peking University Third Hospital, Beijing 100080, China
  • Received:2021-08-10 Revised:2021-10-13 Online:2022-01-12 Published:2022-01-04

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摘要： 【摘要】目的评估维持性血液透析(maintenance hemodialysis,MHD)患者心脏瓣膜钙化(cardiac valve calcification，CVC)与自体动静脉内瘘(arteriovenous fistula AVF)失功之间的关系。方法 收集2019 年6 月～2020 年12 月在北京市海淀医院行MHD 的患者，共95 例。收集其一般资料及实验室检查数据，同时用多普勒超声评估患者心脏瓣膜钙化程度并分为无、轻、中、重度4 个等级。无和轻度钙化视为轻度钙化组，中度和重度钙化视为重度钙化组，分析CVC 相关的临床因素和AVF 失功之间的关系。结果MHD 患者随着年龄增长，瓣膜钙化程度逐渐加重(t=2.463, P＜0.016)；与轻度CVC 组相比，重度CVC组患者血磷(t=- 4.075, P＜0.001)，甲状旁腺激素(t=- 3.398, P＜0.001) 增高；血浆前白蛋白降低(t=-2.412, P=0.018)。多因素回归分析显示CVC 重度钙化是内瘘失功的独立危险因素，重度CVC组患者发生内瘘失功的危险性是轻度CVC组的4.909 倍(95% CI：1.972～12.222，P=0.001)。结论年龄、高血磷、高甲状旁腺激素以及低前白蛋白水平是瓣膜钙化的危险因素，重度CVC 可预测内瘘失功风险。

关键词: 维持性血液透析, 心脏瓣膜钙化, 动静脉内瘘, 相关性

Abstract: 【Abstract】Objective To evaluate the relationship between cardiac valve calcification (CVC) and failure of arteriovenous fistula (AVF) in patients with maintenance hemodialysis (MHD). Methods A total of 95 MHD patients treated at Beijing Haidian Hospital from June 2019 to December 2020 were recruited. Their clinical data and laboratory results were collected. The extent of CVC by color Doppler ultrasonography was classified into four (none, slight, medium, heavy) grades. Patients were then divided into minor CVC group (patients with none or slight CVC) and severe CVC group (patients with medium or heavy CVC). The association
between CVC severity, clinical factors, and failure of AVF was then analyzed by Cox proportional hazard analysis. Results The severity of CVC increased along with the increase of age (t=2.463, P<0.016). Serum phosphate (t=- 4.075, P<0.001) and parathyroid hormone (t=- 3.398, P<0.001) were higher and prealbumin (t= -2.412, P=0.018) was lower in severe CVC group as compared with those in minor CVC group. Multivariate regression analysis showed that severe CVC was the independent risk factor for failure of AVF, and the risk for failure of AVF in severe CVC patients was 4.909 times higher than that in minor CVC patients (OR=4.909, 95% CI：1.972～12.222, P=0.001). Conclusions Older age, higher serum phosphate, parathyroid hormone and TG, and lower serum prealbumin were the risk factors for CVC. Severe CVC can be used to predict the failure of AVF in MHD patients.

Key words: Maintenance hemodialysis, Cardiac valve calcification, Failure of arteriovenous fistula, Relationship

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