中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (05): 329-334.doi: 10.3969/j.issn.1671-4091.2018.05.010

• 血管通路 • 上一篇    下一篇

成熟自体动静脉内瘘失功的慢性危险因素研究

熊良伟1,张祥贵1   

  1. 1. 遵义医学院第五附属(珠海)医院肾内科
  • 收稿日期:2017-09-25 修回日期:2018-03-04 出版日期:2018-05-12 发布日期:2018-05-12

Studies on the chronic risk factors for the dysfunction of mature autogenous arteriovenous fistulas

  • Received:2017-09-25 Revised:2018-03-04 Online:2018-05-12 Published:2018-05-12

PDF

837

摘要： 【摘要】目的通过观察维持性血液透析(maintenance hemodialysis，MHD)患者的一般情况、透析指标、炎症和营养代谢等因素，探讨成熟自体动静脉内瘘(autogenous arteriovenous fistula,AVF)失功的慢性危险因素。方法采用回顾性病例对照分析，从2 个血液透析中心404 例MHD 患者中筛选出248例，分为失功组(n=53)和通畅组(n=195)。收集相关资料，比较两组数据，分析成熟AVF 失功的相关因素；采用logistic 回归对各指标进行多因素分析，探讨成熟AVF 失功的独立危险因素。结果①2 组患者在性别(c2=0.007,P=0.932)、建立AVF 的年龄(c2=5.803,P=0.055)、AVF 的初始血流量(t=- 1.662,P=0.098)、透析龄(t=0.284,P=0.509)、白细胞计数(t'=0.977,P=0.331)、白蛋白(t=0.656, P=0.512)和凝血酶原时间(t=-1.639,P=0.102)方面的差异无统计学意义。②2 组患者在原发病构成(c2=8.809,P=
0.032)、高通量透析时间(t=-5.453, P=0.000)、总透析时间(t'=-3.158, P=0.002)、C 反应蛋白(t=2.325, P=0.021)、血钙(t=-3.404, P=0.001)、血磷(t'=4.135, P=0.000)、钙磷乘积(t'=2.585,P=0.012)、甲状旁腺素(t'=3.528,P=0.001)、胆固醇(t=5.951,P=0.000)和三酰甘油(t=2.054,P=0.041)方面的差异具有统计学意义。③患有糖尿病肾病(OR=8.652，95% CI:2.111～35.460，P=0.003)，患有高血压肾病(OR=7.300，OR 95% CI:1.537～34.672，P=0.012)，血磷升高(OR=6.323，95% CI:1.881～21.253，P=0.003)，甲状旁腺激素升高(OR=1.002，95% CI:1.001～1.004，P=0.007)， 胆固醇升高(OR=5.570，95% CI:2.598～11.943, P＜0.001)的MHD 患者发生成熟AVF 失功的风险更高；低血钙程度更轻(OR=0.066 OR95% CI: 0.007～0.611，P=0.017)，高通量透析时间更长(OR=0.765，95% CI:0.666～0.878，P＜0.001)的MHD 患者发生成熟AVF 失功的风险更低。结论①原发病构成、高通量透析时间、总透析时间、C 反应蛋白、血钙、血磷、钙磷乘积、甲状旁腺素、胆固醇和三酰甘油是成熟AVF 失功的相关因素。②糖尿病肾病、高血压肾病、钙磷代谢紊乱和血脂代谢紊乱是成熟AVF 失功的独立危险因素。3 在临床工作中适当增加高通量透析时间有利于保护成熟AVF的功能。

关键词: 成熟自体动静脉内瘘失功, 独立危险因素, 高通量透析时间

Abstract: 【Abstract】Objective To explore the chronic risk factors for the dysfunction of mature autogenous arteriovenous fistulas (AVFs) in maintenance hemodialysis (MHD) patients through the analyses of their general condition, dialysis index, inflammation and nutritional status. Methods This was a retrospective case-control analysis. A total of 248 MHD patients were recruited from the 404 MHD patients treated in two hemodialysis centers, and divided into dysfunction group (n=53) and patent group (n=195). Clinical data were collected and compared between the two groups in order to find out the risk factors for dysfunction of mature AVFs. Multivariate logistic regression was also used to investigate the independent risk factors for dysfunction of mature AVFs. Results ①There were no significant differences in gender (c2=0.007, P=0.932), AVF age (c2=5.803, P=0.055), initial blood flow in AVF (t=- 1.662, P=0.098), dialysis age (t=0.284, P=0.509), white blood cell count (t '=0.977, P=0.331), serum albumin (t=0.656, P=0.512) and prothrombin time (t=-1.639, P=0.102) between the two groups. ②There were significant differences in primary disease (c2=8.809, P=0.032), high flux dialysis duration (t=- 5.453, P＜0.001), total dialysis duration (t' =- 3.158, P=0.002), C- reactive protein (t=2.325, P=0.021), serum calcium (t=-3.404, P=0.001), serum phosphorus (t'=4.135, P=0.000), calcium-phosphorus product (t'=2.585, P=0.012), serum parathyroid hormone (t'=3.528, P=0.001), serum cholesterol (t=5.951, P＜0.001) and serum triglycerides (t=2.054, P=0.041) between the two groups. ③The risk for dysfunction of mature AVFs was higher in MHD patients with diabetic nephropathy (OR=8.652, 95% CI: 2.111～35.460, P=0.003), hypertension nephropathy (OR=7.300, 95% CI: 1.537～34.672, P=0.012), higher serumphosphorus (OR=6.323, 95% CI: 1.881～21.253, P=0.003), higher parathyroid hormone (OR=1.002, 95% CI:1.001～1.004, P=0.007) and higher serum cholesterol (OR=5.570, 95% CI: 2.598～11.943, P＜0.001), and was lower in those with moderate hypocalcemia (OR=0.066, 95% CI: 0.007～0.611, P=0.017) and longer high flux dialysis period (OR=0.765, 95% CI: 0.666～0.878, P＜0.001). Conclusion ①The related risk factors for the dysfunction of mature AVFs included primary disease, high flux dialysis duration, total dialysis duration, C-reactive protein, serum calcium, serum phosphorus, calcium-phosphorus product, serum parathyroid hormone, serum cholesterol and serum triglycerides. ②The independent risk factors for the dysfunction of mature AVFs included diabetic nephropathy, hypertension nephropathy and calcium, phosphorus and lipid metabolism disturbances. ③ Clinically, increase of high flux dialysis period is useful for the prevention of mature AVF from dysfunctioning.

Key words: Mature autogenous arteriovenous fistula, Independent risk factors, High flux dialysis time