中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (07): 542-545,556.doi: 10.3969/j.issn.1671-4091.2023.07.015

• 血管通路 • 上一篇    下一篇

营养控制状态对终末期肾病患者动静脉内瘘晚期失功的影响

刘海燕    赵娜新   向 攀   任雯雯    曾志立   董庆华   

  1. 100015 北京，1首都医科大学附属北京地坛医院肾内科
  • 收稿日期:2023-01-09 修回日期:2023-04-28 出版日期:2023-07-12 发布日期:2023-07-12
  • 通讯作者: 向攀 E-mail:Xiangpanbj@163.com

Effect of controlling nutritional status on late failure of hemodialysis arteriovenous fistula in patients with end-stage renal disease

LIU Hai-yan, ZHAO Na-xin, XIANG Pan, REN Wen-wen, ZENG Zhi-li, DONG Qing-hua   

  1. Department of Nephrology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2023-01-09 Revised:2023-04-28 Online:2023-07-12 Published:2023-07-12
  • Contact: 100015 北京，1首都医科大学附属北京地坛医院肾内科 E-mail:Xiangpanbj@163.com

PDF

23

摘要： 目的 探讨营养控制状态与终末期肾病(end-stage renal disease，ESRD)患者动静脉内瘘(arteriovenous fistula，AVF)晚期失功的关系。 方法 纳入2021年3月～2022年5月首都医科大学附属北京地坛医院肾内科收治的ESRD患者。根据AVF手术前营养控制状态(controlling nutritional status，CONUT)评分分为正常组、轻度组和中重度组。记录患者AVF手术前基线资料、实验室指标，随访6个月记录AVF晚期失功情况。分析营养控制状态对ESRD患者AVF晚期失功的影响。 结果 共纳入100例患者，正常组、轻度组、中重度组分别为28例、50例、22例。3组患者淋巴细胞计数(Lym)、白蛋白(ALB)、总胆固醇(TC)、尿酸(UA)、C反应蛋白(CRP)比较，差异有统计学意义(F/P=7331.645/＜0.001、82.823/＜0.001、27.704/＜0.001、14.530/＜0.001、6.128/＜0.001)。随访期间AVF晚期失功率为31.00%，3组AVF晚期失功率比较差异有统计学意义(χ2=13.363，P=0.001)，中重度组AVF晚期失功率高于正常组(χ2=13.732，P＜0.001)，轻度组高于正常组(χ2=7.026，P=0.008)；中重度组AVF晚期失功率与轻度组比较，差异无统计学意义(χ2=2.681，P= 0.102)。Logistic回归显示：营养不良[轻度：OR(95% CI)=10.321(1.297～81.978)，P=0.027；中重度：OR(95% CI)=18.559(1.484～232.091)，P=0.023]是ESRD患者血液透析AVF晚期失功的影响因素。 结论 ESRD患者血液透析AVF晚期失功与中重度营养不良有关，通过营养控制状态评估有助于筛选出存在AVF晚期失功风险的ESRD患者。

关键词: 终末期肾病, 动静脉内瘘晚期失功, 营养控制状态

Abstract: Objective  To investigate the relationship between controlling nutritional status (CONUT) and late arteriovenous fistula (AVF) failure in patients with end-stage renal disease (ESRD).  Methods  The ESRD patients admitted to the Department of Nephrology, Beijing Ditan Hospital Affiliated to Capital Medical University from March 2021 to May 2022 were included in this study. They were divided into normal group, mild group, and moderate and severe group according to the preoperative CONUT score. Baseline data and laboratory indexes before AVF surgery were recorded. The late AVF failure was recorded during the follow-up period of 6 months after the surgery. The effect of CONUT on late AVF failure was analyzed.  Results  A total of 100 patients were enrolled in this study, including 28 cases in the normal group, 50 cases in the mild group and 22 cases in the moderate and severe group. Levels of lymphocyte count (Lym), albumin (ALB), total cholesterol (TC), uric acid (UA) and C-reactive protein (CRP) were different among the three groups (F=7331.645, 82.823, 27.704, 14.530 and 6.128 respectively; P<0.001). The rate of late AVF failure was 31.00 % in the follow-up period of 6 months. The rate of late AVF failure was statistically different among the three groups of patients (χ2=13.363, P=0.001), with higher in moderate and severe group than in normal group (χ2=13.732, P<0.001) and higher in mild group than in normal group (χ2=7.026, P=0.008), but without statistical significance between mild group and moderate to severe group (χ2=2.681, P=0.102). Logistic regression showed that malnutrition (mild: OR=10.321, 95% CI 1.297～81.978, P=0.027; moderate and severe: OR=18.559, 95% CI 1.484～232.091,P=0.023) was a risk factor for late AVF failure in ESRD patients.  Conclusion The late AVF failure in ESRD patients on hemodialysis is related to moderate and severe malnutrition. CONUT scoring is helpful for the screening of the ESRD patients with risk of late AVF failure.

Key words: End-stage renal disease, Late failure of arteriovenous fistula, Controlling nutritional status

中图分类号: