中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (07): 530-535.doi: 10.3969/j.issn.1671-4091.2022.07.015

• 血管通路 • 上一篇    下一篇

非糖尿病维持性血液透析患者自体动静脉内瘘失功的影响因素分析

武玲宇   樊佩琦    郭罡玲     李 静    王利华   

  1. 030001 太原，1山西医科大学第二医院肾内科 2山西省卫健委医疗质量控制管理中心血液净化质量
    控制中心

  • 收稿日期:2022-03-07 修回日期:2022-05-05 出版日期:2022-07-12 发布日期:2022-07-12
  • 通讯作者: 李静 E-mail:lijingshiji@163.com
  • 基金资助:
    山西省卫生计生委科研课题(2017051)

AThe influencing factors of arteriovenous fistula dysfunction in non-diabetic maintenance hemodialysis patients

  1. Department of Nephrology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China; 2Blood Purification Quality
    Control Center of Medical Quality Control and Management Center, Health Commission of Shanxi Provence,
    Taiyuan 030001, China
  • Received:2022-03-07 Revised:2022-05-05 Online:2022-07-12 Published:2022-07-12

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摘要： 目的 了解非糖尿病血液透析患者自体动静脉内瘘(autologous arteriovenous fistula，
AVF)的失功情况，并探讨影响AVF失功的相关因素。 方法 以2021年1月～6月于山西医科大学第二医
院血液透析中心接受维持性血液透析(maintenance hemodialysis，MHD)治疗且临床资料完整的92名非
糖尿病患者为研究对象，根据AVF失功诊断标准将患者分为失功组及非失功组，回顾性分析2组各项临床
资料的差异。采用多因素COX风险回归模型分析AVF失功的影响因素，Kaplan-Meier方法绘制生存曲
线。 结果 与AVF非失功组(n=69)相比，失功组(n=23)患者舒张压(t=-5.143,P＜0.001)、头静脉内径
(Z=-3.847,P＜0.001)、桡动脉内径(Z=-3.734,P＜0.001)、血清白蛋白水平(t=-3.741,P=0.001)较低，而
血磷(t=2.076,P =0.041)、钙磷乘积(t=2.444,P=0.016)、C反应蛋白(Z=2.477,P=0.013)和营养不良-炎
症-动脉粥样硬化综合征(malnutrition- inflammation- atherosclerosis syndrome,MIAS)发生率
(χ2=4.943,P =0.026)高于AVF非失功组。多因素COX回归显示，较高舒张压(HR=0.957，95% CI：0.917～
0.998，P =0.039)、较高血清白蛋白(HR=0.831，95% CI：0.767～0.899，P＜0.001)、较大桡动脉内径
(HR=0.079，95% CI：0.019～0.338，P =0.001)是 AVF 失功的保护因素，而合并 MIAS(HR=4.059，95% CI：
1.128～14.614，P =0.032)是AVF失功的危险因素。Kaplan-Meier生存曲线显示，合并低白蛋白血症患
者的AVF使用时间明显短于非低白蛋白血症患者的AVF使用时间(Log-rank χ2=27.776，P＜0.001)。 结

论 较高的舒张压是非糖尿病MHD患者AVF失功的保护因素，而低白蛋白血症、合并MIAS是非糖尿病患
者AVF失功的危险因素。

关键词:

维持性血液透析, 自体动静脉内瘘, 影响因素, 内瘘失功, 生存分析

Abstract: Objective To investigate the failure of arteriovenous fistula (AVF) in non-diabetic hemodialysis patients and to explore the related factors affecting the AVF function. Methods Ninety-two non-diabetic
patients who received maintenance hemodialysis (MHD) in the Hemodialysis Center of The Second Hospital
of Shanxi Medical University from January to June 2021 and had complete clinical data were enrolled in this
study. The patients were divided into AVF normal group and AVF failure group according to the diagnosis criteria of AVF failure. The differences in clinical data were retrospectively analyzed between the two groups.
Multivariate Cox risk regression model was used to analyze the influencing factors Results Diastolic blood
pressure (t=-5.143, P< 0.001), cephalic vein diameter (Z=-3.847, P< 0.001), radial artery diameter (Z=-3.734,
P<0.001), and serum albumin (t=-3.741, P=0.001) were lower, while serum phosphorus (t=2.076, P=0.041),
calcium-phosphorus product (t=2.444, P=0.016), C-reactive protein (Z=2.477, P=0.013) and the incidence of
malnutrition-inflammation-atherosclerosis syndrome (MIAS) (χ2=4.943, P=0.026) were higher in AVF failure
group as compared those in AVF normal group. Multivariate Cox regression showed that higher diastolic
blood pressure (HR=0.957, 95% CI：0.917～0.998, P=0.039), higher serum albumin (HR=0.831, 95% CI：
0.767～0.899, P<0.001), and larger radial artery diameter (HR=0.079, 95% CI 0.019～0.338, P=0.001) were
the protective factors for functional AVF, while the complication of MIAS (HR=4.059, 95% CI 1.128～
14.614, P=0.032) was a risk factor for AVF failure. Kaplan-Meier survival curve showed that the AVF lifetime
in patients with hypoalbuminemia was significantly shorter than that in patients without hypoalbuminemia
(log-rank test: c2=27.776, P<0.001). Conclusion Higher diastolic blood pressure is a protective factor for
functional AVF, while hypoalbuminemia and the complication of MIAS are risk factors for AVF failure in nondiabetic MHD patients.

Key words: Maintenance hemodialysis, Arteriovenous fistula, Influencing factors, Fistula failure, Survival analysis

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