中国血液净化 ›› 2023, Vol. 22 ›› Issue (02): 86-89.doi: 10.3969/j.issn.1671-4091.2023.02.002

• 临床研究 • 上一篇    下一篇

动静脉内瘘功能丧失危险因素及与主动脉弓钙化的关系研究

严爱宏   包秀芹   张巧根   

  1. 225300 泰州,1江苏省泰州市人民医院肾内科
  • 收稿日期:2022-07-14 修回日期:2022-11-15 出版日期:2023-02-12 发布日期:2023-02-12
  • 通讯作者: 包秀芹 E-mail:2993648058@qq.com

Risk factors of arteriovenous fistula dysfunction and relationship with aortic arch calcification

YAN Ai-hong, BAO Xiu-qin, ZHANG Qiao-gen   

  1. Department of Nephrology, The People's Hospital of Taizhou City, Jiangsu 225300, China
  • Received:2022-07-14 Revised:2022-11-15 Online:2023-02-12 Published:2023-02-12
  • Contact: 225300 泰州,1江苏省泰州市人民医院肾内科 E-mail:2993648058@qq.com

摘要: 目的  探讨维持性血液透析(maintenance hemodialysis,MHD)患者动静脉内瘘(arteriovenous fistula,AVF)功能丧失危险因素及与主动脉弓钙化的关系。 方法  纳入2015年1月~2020年1月于泰州市人民医院治疗并接受规律随访的MHD患者共185例,根据是否存在主动脉弓钙化分为钙化组(138例)和无钙化组(47例),比较2组临床特征资料,采用Logistic回归模型确定AVF功能丧失独立危险因素,分析主动脉弓钙化评分与AVF功能丧失间相关性,描绘ROC曲线评价主动脉弓钙化评分用于AVF功能丧失发生预测临床效能。 结果  钙化组年龄、脉压、校正血钙、血磷、C反应蛋白(CRP)及AVF功能丧失比例均高于无钙化组(t/χ2=-7.775、-5.667、-9.171、-3.483、-7.762、8.128,P<0.001、<0.001、      <0.001、0.001、<0.001、0.004);钙化组舒张压(diastolic blood pressure,DBP)和血全段甲状旁腺激素(iPTH)水平均低于无钙化组(t=2.652、3.691,P =0.009、<0.001);Logistic回归模型单因素和多因素分析结果显示:校正血钙高水平(OR=11.642,95%CI: 1.382~25.061,P<0.001)、血磷高水平(OR=4.141,95% CI:1.041~8.484、P =0.031)、CRP水平(OR=5.381,95% CI:1.201~13.110、P<0.001)及主动脉弓钙化形成(OR =5.802,95%CI:1.353~15.112、P<0.001)均是MHD患者AVF功能丧失独立危险因素;Spearman检验分析结果显示:主动脉弓钙化评分与AVF功能丧失呈正相关(r=0.811,P<0.001);受试者工作特征(ROC)曲线分析结果显示:主动脉弓钙化评分用于AVF功能丧失发生预测AUC为0.884(95%CI: 0.832~0.971),最佳截断值为2分,敏感性度和特异度分别为78.41%,86.33%。 结论  MHD患者AVF功能丧失与主动脉弓钙化形成、钙磷水平异常及炎症细胞因子分泌亢进关系密切;同时主动脉弓钙化程度可用于AVF功能丧失预测。

关键词: 血液透析, 动静脉内瘘, 主动脉弓, 钙化

Abstract: Objective  To investigate the risk factors of  (arteriovenous fistula,AVF) dysfunction in MHD patients and the relationship with aortic arch calcification.  Methods  185 patients with MHD by regular follow-up were retrospectively chosen in the period of January 2015 to January 2020. The enrolled patients were divided into calcified group (138 cases) and non-calcified group (47 cases) according to the presence of aortic arch calcification. The clinical characteristics of the two groups were compared and Logistic regression model was used to explore the independent risk factors of AVF dysfunction. The correlation between aortic arch calcification score and AVF dysfunction was analyzed and ROC curve was drawn to evaluate the predict efficacy on AVF dysfunction of aortic arch calcification score.  Results  The age, pulse pressure difference, corrected calcium, blood phosphorus levels and CRP and AVF function loss rate in calcified group were significantly higher than non-calcified group (P<0.05). The levels of DBP and iPTH in calcified group were significantly lower than non-calcified group (P<0.05). Univariate and multivariate analysis results of logistic regression models showed that higher corrected calcium level, higher blood phosphorus level, higher CRP and aortic arch calcification were independent risk factors for AVF dysfunction in patients with MHD (P<0.05). Spearman test showed that aortic arch calcification score was positively correlated with AVF dysfunction (P<0.05). ROC curve analysis showed that AUC of aortic arch calcification score in predicting of AVF dysfunction was 0.88 (95% CI: 0.83~0.97), the optimal cut-off value was 2 points, and the sensitivity and specificity were 78.41% and 86.33%, respectively.  Conclusion  The AVF dysfunction in patients with MHD was closely related to aortic arch calcification, abnormal calcium and phosphorus levels, and inflammatory cytokine secretion, and the degree of aortic arch calcification can be used to predict the risk of AVF dysfunction. 

Key words: Hemodialysis, Arteriovenous fistula, Aortic arch, Calcification

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