中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (06): 393-397.doi: 10.3969/j.issn.1671-4091.2020.06.009

• 血管通路 • 上一篇    下一篇

维持性血液透析患者自体动静脉内瘘功能障碍影响因素分析

徐耀1,徐艳1,郝冬冬1,牟洪宾1,徐军1,刘昌华1   

  1. 1扬州大学临床医学院江苏省苏北人民医院肾内科
  • 收稿日期:2020-02-24 修回日期:2020-03-30 出版日期:2020-06-12 发布日期:2020-06-24
  • 通讯作者: 刘昌华 yzlch2015@163.com E-mail:yzlch2015@163.com
  • 基金资助:
    扬州市科技局社发项目(SQZ201430047)

Analysis of influencing factors of autogenous arteriovenous fistula dysfunction in maintenance hemodialysis patients#br#

  1. 1Department of Nephrology, Jiangsu Province Subei People's Hospital, Clinical Medicine College, Yangzhou University,
    Yangzhou 225009, China

  • Received:2020-02-24 Revised:2020-03-30 Online:2020-06-12 Published:2020-06-24

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摘要： 【摘要】目的探讨维持性血液透析患者klotho G-395A 基因多态性与自体动静脉内瘘失功的相关性。方法前瞻性观察2015 年01 月～2018 年01 月于苏北人民医院行自体动静脉内瘘(arteriovenous fistula，AVF)手术的维持性透析患者198 例，采用一代测序法检测Klotho G-395A 位点的单核苷酸多态性，应用酶联免疫吸附试验检测血清klotho 蛋白及成纤维细胞生长因子(fibroblast growth factor 23，FGF23)水平，收集所有患者的一般及临床生化资料，采用COX 回归分析法探讨影响AVF 使用寿命的相关因素。结果198 例患者随访2 年，失访5 例，死亡3 例，AVF 的1 年、2 年生存率分别为88.9%、77.8%。根据A 等位基因将患者分为A 等位基因携带者(GA+AA)型和非携带者GG 型，(GA+AA)型内瘘通畅率低于GG 型(χ2=9.062，P=0.003)。多因素COX 比例风险模型分析中，基因型、置管史和FGF23 是AVF 远期通畅的影响因素(HR 值分别为2.664，2.299，1.002；95%CI 分别为1.594～4.452，1.048～5.045，1.000～1.003；P 值分别为＜0.001，0.038，0.009)。结论Klotho 基因G-395A 多态性可能与透析患者的自体动静脉内瘘远期通畅有关，A 等位基因可能为其发生AVF 失功的独立危险因素。

关键词: klotho 基因, 成纤维细胞生长因子, klotho蛋白, 维持性血液透析, 自体动静脉内瘘

Abstract: 【Abstract】Objective To investigate the correlation between G-395A polymorphism in klotho gene and autogenous arteriovenous fistula (AVF) dysfunction in maintenance hemodialysis (MHD) patients. Methods This prospective study included 198 MHD patients undergoing AVF surgery at Jiangsu Province Subei People's Hospital in the period from January 2015 to January 2018. The singlEnucleotide polymorphism at the G-395A in Klotho gene was identified by first generation sequencing. Serum klotho and FGF23 levels were measured by ELISA. Clinical and biochemical data were collected. Cox regression model was used to analyze the relevant factors affecting the life span of AVF. Results These MHD patients were followed up for 2 years, in which 5 lost the follow-up, and 3 died. The survival rates of AVF after one and two years were 88.9% and 77.8%, respectively. According to the presence or absence of A allele, the patients were divided into A allele carriers (GA genotype or AA genotype) and non-A carriers (GG genotype). The patency rate was lower in A allele carriers than in non-A carriers (χ2=9.062, P=0.003). Multivariate Cox proportional hazards model showed that genotype (HR=2.664, 95% CI: 1.594-～4.452, P<0.001), history of catheterization (HR=2.299, 95% CI:1.048～5.045, P=0.038) and FGF23 level (HR=1.002, 95% CI: 1.000～1.003, P=0.009) were the factors influencing long-term patency of AVF. Conclusion The G-395A polymorphism in klotho gene may relate to the long-term patency of autogenous AVF in MHD patients, and A allele may be an independent risk factor for AVF failure.

Key words: Klotho gene, Fibroblast growth factor 23, Klotho protein, Maintenance hemodialysis, Autologous arteriovenous fistula

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