中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (10): 780-784.doi: 10.3969/j.issn.1671-4091.2023.10.014

• 血管通路 • 上一篇    下一篇

维持性血液透析患者超声下桡动脉钙化与AVF功能相关性研究

王 霄   管文瑜   王 丹   高庆贞   

  1. 250013 济南，1山东省荣军总医院
    250013 济南，2山东第一医科大学附属中心医院肾脏病/血液净化科
  • 收稿日期:2023-05-15 修回日期:2023-08-01 出版日期:2023-10-12 发布日期:2023-09-28
  • 通讯作者: 高庆贞 E-mail:gaoqingzhen@163.com
  • 基金资助:
    山东省济南市卫生健康委员会科技计划项目(2017-1-23)

Correlation between radial artery calcification and AVF function by ultrasound examination in maintenance hemodialysis patients

WANG Xiao, GUAN Wen-yu, Wang Dan, GAO Qing-zhen   

  1. Department of Nephrology, Shandong Rongjun General Hospital, Jinan 250013, China; 2Department of Nephrology and Blood Purification, The Central Hospital Affiliated to Shandong First Medical University, Jinan 250013, China
  • Received:2023-05-15 Revised:2023-08-01 Online:2023-10-12 Published:2023-09-28
  • Contact: 250013 济南，2山东第一医科大学附属中心医院肾脏病/血液净化科 E-mail:gaoqingzhen@163.com

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摘要： 目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者多普勒超声下前臂动静脉内瘘(arteriovenous fistula,AVF)的桡动脉钙化(radial artery calcification,RAC)情况以及对AVF功能的影响。 方法  应用多普勒超声评估AVF的RAC程度并分组，记录超声功能参数。收集患者资料、化验结果行统计学分析。 结果  280例患者入组，102例(36%)患者存在不同程度的RAC。RAC与桡动脉直径(r=-0.333,P＜0.001)、AVF血流量(r=-0.257,P＜0.001)呈负相关，与短期AVF功能不良无明显相关性(r=-0.031,P=0.600)。不同钙化程度分组患者间桡动脉直径(H=38.861，P＜0.001)、AVF血流量 (H=24.035，P＜0.001)存在显著差异。无钙化组患者桡动脉直径与轻、中、重度钙化组的比较均有统计学意义(Z=37.326、91.820、76.524，P=0.012、＜0.001、＜0.001)，无钙化组的AVF血流量与中、重度钙化组的差异有统计学意义(Z=60.696、59.501，P=0.024、＜0.001)，其余组间比较差异无统计学意义(P＞0.05)。组间比较显示钙化组患者性别(χ2=5.258,P=0.022)，年龄(t=-1.975,P=0.049)、透析龄      (Z=3.180,P=0.001)、吻合方式(χ2=7.495,P=0.006)、糖尿病(χ2=13.252,P＜0.001)、全段甲状旁腺激素(intact parathyroid hormone,iPTH)水平(Z=-2.022,P=0.043)较无钙化组差异有统计学意义。多因素Logistic回归分析显示高透析龄(OR=1.010,95% CI:1.004～1.016，P=0.001)、糖尿病(OR=3.101,95% CI:1.713～5.615，P＜0.001)、高iPTH(OR=1.002,95% CI:1.000～1.004，P=0.033)水平是MHD患者发生RAC的独立危险因素。结论  RAC与短期AVF功能不良无明显相关性，但随着钙化程度的加重，桡动脉直径和AVF血流量会越低。经超声评估RAC及钙化程度具有良好临床价值。

关键词: 血液透析, 动静脉内瘘, 多普勒超声, 桡动脉钙化

Abstract: Objective  To investigate calcification of the radial artery (RAC) in arteriovenous fistula (AVF) and its effects on function of the AVF by Doppler ultrasound examination in maintenance hemodialysis (MHD) patients.  Methods  The RAC degree of AVF was evaluated by Doppler ultrasound examination, and the patients were then grouped. The ultrasound parameters for the function of AVF were recorded. Clinical data and quality control of the laboratory results were recruited for statistical analyses. Results  A total of 280 patients were enrolled in this study, and 102 patients (36%) of them had various degrees of RAC in AVF. RAC was negatively correlated with radial artery diameter (r=-0.333, P<0.001) and blood flow in AVF (r=-0.257, P<0.001), but not with short-term AVF dysfunction (r=-0.031, P=0.600). Radial artery diameter (H=38.861, P<0.001) and blood flow in AVF (H=24.035, P<0.001) were significantly different among the groups with different degrees of RAC. The radial artery diameter in patients without RAC was statistically different from that in patients with mild, moderate and severe RAC (Z=37.326, 91.820 and 76.524 respectively; P=0.012, <0.001 and <0.001 respectively); the blood flow in AVF in patients without RAC was statistically different from that in patients with moderate and severe RAC (Z=60.696 and 59.501; P=0.024 and <0.001); the comparisons among other groups had no statistical differences (P>0.05). In patients with RAC, gender (χ2=5.258, P=0.022), age (t=-1.975, P=0.049), dialysis age (Z=3.180, P=0.001), anastomosis method (χ2=7.495, P=0.006), diabetes (χ2=13.252, P<0.001), and serum iPTH level (Z=-2.022, P=0.043) were statistical different from those in patients without RAC. Multivariate logistic regression showed that longer dialysis age (OR=1.010, 95% CI:1.004~1.016, P=0.001), diabetes (OR=3.101, 95% CI:1.713~5.615, P<0.001), and higher serum iPTH (OR=1.002, 95% CI:1.000~1.004, P=0.033) were the independent risk factors for RAC in MHD patients. Conclusion  RAC is unrelated to the short-term AVF dysfunction. When RAC progresses, radial artery diameter becomes smaller and blood flow in AVF decreases. Ultrasound examination has better clinical values in the evaluation of RAC and its degree.

Key words: Hemodialysis, Arteriovenous fistula, Doppler ultrasound, Radial artery calcification

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