中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (06): 405-409.doi: 10.3969/j.issn.1671-4091.2021.06.013

• 血管通路 • 上一篇    下一篇

血液透析间期不同程度体质量增长对患者自体动静脉内瘘失功的影响

陈迎归1,宋利2,孙春艳1,2,周丽芳1,2,郑淑倩1,全梓林2,赵立艳2,崔冬梅2,钟咪2,赵宜娜2,3,符霞1,2,3   

  1. 1南方医科大学护理学院
    2广东省人民医院(广东省医学科学院)肾内科
    3汕头大学医学院
  • 收稿日期:2021-01-28 修回日期:2021-03-08 出版日期:2021-06-12 发布日期:2021-06-17
  • 通讯作者: 符霞 fuxia0027@gdph.org.cn E-mail:fuxia0027@gdph.org.cn
  • 基金资助:
    广东省医学科学技术研究基金项目(A2020635)

Impact of different degrees of interdialytic weight gain on the dysfunction of autogenous arteriovenous fistula in maintenance hemodialysis patients

  1. 1 School of Nursing, Southern Medical University, Guangzhou 510515, China;  2 Division of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China;  3 Shan Tou University Medical College, Shan Tou 515063, China
  • Received:2021-01-28 Revised:2021-03-08 Online:2021-06-12 Published:2021-06-17
  • Contact: Xia -FU E-mail:fuxia0027@gdph.org.cn

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摘要： 【摘要】目的探讨血液透析间期不同程度体质量增长对患者自体动静脉内瘘(arteriovenous fistula，AVF)失功的影响。方法采用回顾性队列研究设计，选取2009 年1 月～2019 年1 月在广东省人民医院接受维持性血液透析(maintenance hemodialysis，MHD)治疗的患者577 例,于2019 年1 月建立队列。收集患者入组前的临床资料，以患者2009 年每次透析前体质量和干体质量计算每次透析间期体质量增长(interdialytic weight gain，IDWG)并取平均值，观察指标为AVF 失功。结果研究对象分为IDWG≤4%组和IDWG＞4%组，用倾向性评分匹配法控制2 组混杂变量，共414 例患者完成1：1 匹配。匹配前后IDWG＞4% 组AVF 失功率均高于IDWG≤4% 组[34.2% 比65.8% ,χ2=5.718,P=0.017；14.5% 比22.7% ,χ2=4.611,P=0.032]；二元Logistic 回归分析结果显示，年龄(OR=3.393, 95% CI：1.861～6.184,P＜0.001)、IDWG(OR =1.967,95% CI：1.157～3.347,P=0.013)、血清白蛋白(OR=1.759,95% CI：1.034～2.990,P =0.037)、左心室质量指数(OR=1.008,95% CI：1.002～1.013,P=0.010)是AVF 失功的独立危险因素。结论IDWG 超过4%是MHD 患者AVF 失功的重要危险因素，特别是对于年龄大于60 岁、血清白蛋白低于35g/L、左心室质量指数高的患者。

关键词: 血液透析, 透析间期体质量增长, 动静脉内瘘失功, 倾向性评分匹配法

Abstract: 【Abstract】Objective To explore the effect of interdialytic weight gain (IDWG) on the dysfunction of arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients. Methods A total of 577 MHD patients treated in Guangdong Provincial People’s Hospital during the period from 2009 to 2019 were recruited for a retrospective and cohort study. Clinical data of the patients before entering the study were collected. The average IDWG was calculated based on the predialysis body weight and dry weight in every dialysis session in 2009. The observation index was AVF dysfunction. Results The MHD patients were divided into IDWG ≤4% group and IDWG >4% group. The two groups of confounding variables were controlled by propensity score matching method and a total of 414 patients completed 1:1 matching. Before and after the matching, the AVF dysfunction in IDWG >4% group was higher than that in IDWG≤4% group (before matching: 34.2% vs. 65.8%, χ2=5.718, P=0.017; after matching: 14.5% vs. 22.7%, χ2=4.611, P=0.032). Binary logistic regression analysis showed that age (OR=3.393, 95% CI 1.861～6.184, P<0.001), IDWG (OR=1.967, 95% CI 1.157～3.347, P=0.013), serum albumin (OR=1.759, 95% CI 1.034～2.990, P=0.037) and left ventricular mass index (OR=1.008, 95% CI 1.002～1.013, P=0.010) were the independent risk factors for AVF dysfunction. Conclusion
IDWG over 4% was an important risk factor for AVF dysfunction in MHD patients, especially in patients >60 years old, and with serum albumin <35g/L and higher left ventricular mass index.

Key words: Hemodialysis, Interdialytic weight gain, Arteriovenous fistula, Dysfunction, Propensity score matching

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