中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (09): 681-685.doi: 10.3969/j.issn.1671-4091.2022.09.013

• 血管通路 • 上一篇    下一篇

不同血管通路类型对维持性血液透析患者生存影响的研究

安 娜    李 洪     陈汝满     王春莉    白亚飞    徐明芝   王翠娟   

  1. 570311 海口，海南省人民医院-海南医学院附属海南医院血液净化中心
  • 收稿日期:2022-02-08 修回日期:2022-06-24 出版日期:2022-09-12 发布日期:2022-09-06
  • 通讯作者: 李洪 E-mail:hpph01＠163.com
  • 基金资助:
    海南省医药卫生科研项目(20A200225)；海南省临床医学中心建设项目

Effects of different types of vascular access on survival of maintenance hemodialysis patients 

AN Na,  LI Hong,   CHEN Ru-man,   WANG Chun-li,   BAI Ya-fei,   XU Ming-zhi,  WANG Cui-juan   

  1. Blood Purification Center, Hainan Provincial People’s Hospital (Hainan Hospital Affiliated to Hainan Medical University), Haikou 570311, China
  • Received:2022-02-08 Revised:2022-06-24 Online:2022-09-12 Published:2022-09-06
  • Contact: LI Hong E-mail:hpph01＠163.com

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摘要： 目的  探讨不同血管通路类型对维持性血液透析(maintenance hemodialysis,MHD)患者3年生存的影响。 方法 前瞻性队列研究设计，纳入2017年1月1日～2017年12月31日在海南省人民医院血液透析的MHD患者216例,随访3年。根据血管通路类型分2组：自体动静脉内瘘(autostatic arteriovenous fistula,AVF)组和带隧道涤纶套导管(tunneled cuffed catheter,TCC)组。观察终点为患者3年全因死亡。 结果  ①216例患者中年龄 ≥ 60岁者86例(39.8%)，糖尿病肾病60例(27.8%)，男性132例(61.1%)， TCC组55例(25.5%)。②2组死亡原因构成比无统计学差异(χ2=0.676，P=0.879)；AVF组第一位死亡原因是心血管事件(39.5%)，其次是感染(30.2%)，TCC组分别是感染(39.3%)和心血管事件(35.7%)。③随访期间AVF组累积生存率高于TCC组(χ2=9.618，P=0.002)。④单因素分析显示：年龄 (OR=2.854,95% CI：1.766～4.612，P＜0.001)、透析龄(OR=0.973,95% CI：0.963～0.983，P＜0.001)、原发病(OR=2.296,95% CI：1.435～3.673，P=0.001)、血管通路类型(OR=2.091,95% CI：1.294～3.378，P =0.003)、白蛋白(OR=4.281,95% CI：2.050～8.938，P＜0.001)和胸部CT影像(OR=0.409,95% CI：0.255～0.655，P＜0.001)是影响患者全因死亡的重要因素。⑤多因素COX回归分析：校正原发病、年龄、透析龄、白蛋白、血管通路及胸部CT影像后，维持性血管通路类型(OR=0.921,95%CI：0.545～1.557，P=0.759)对全因死亡无直接影响；透析龄(OR=0.976，95% CI：0.966～0.986，P＜0.001)、低白蛋白(OR=2.898,95% CI：1.327～6.330，P=0.008)和胸部CT影像改变(OR=2.060,95% CI：1.258～3.376，P=0.004)是全因死亡的独立危险因素。 结论  AVF与TCC作为MHD血管通路对患者生存无直接影响；积极纠正营养不良，提高白蛋白水平及有效防治肺部炎症，改善CT影像异常可提高患者生存率。

关键词: 维持性血液透析, 自体动静脉内瘘, 导管, 生存率

Abstract: Objective  To investigate the effects of different vascular access types on survival of maintenance hemodialysis (MHD) patients.  Methods  A prospective cohort study was performed, which included 216 MHD patients treated in Hainan Provincial People's Hospital from January 1, 2017 to December 31, 2017. The patients were followed up for 3 years. According to vascular access type, they were divided into 2 groups: autologous arteriovenous fistula (AVF) group and tunneled cuffed catheter (TCC) group. The observation endpoint was all-cause death in the follow-up period of 3 years.  Results  ①In the 216 MHD patients, 86 patients were in the age of ≥60 years, 60 patients (27.8%) had diabetic nephropathy, 132 (61.1%) were males, 55 patients (25.5%) were in the TCC group.  ②The cause of death was similar between the two groups (χ2=0.676, P=0.879). In AVF group, the first cause of death was cardiovascular events (39.5%), followed by infection (30.2%); in TCC group, the first cause of death was infection (39.3%), followed by cardiovascular events (35.7 %). ③The cumulative survival rate in the 3-year follow-up period was higher in AVF group than in TCC group (χ2=9.618, P=0.002). ④ Univariate regression showed that age (OR=2.854, 95% CI 1.766～4.612, P<0.001), dialysis vintage (OR=0.973, 95% CI 0.963～0.983, P<0.001), primary disease (OR=2.296, 95% CI 1.435～3.673, P=0.001), vascular access (OR=2.091, 95% CI 1.294～3.378, P=0.003), albumin (OR=4.281, 95% CI 2.050～8.938, P<0.001) and chest CT findings (OR=0.409, 95% CI 0.255～0.655, P<0.001) were the important factors affecting all-cause death. ⑤ Multivariate Cox regression after correction for primary disease, age, dialysis vintage, hemoglobin, albumin, chest CT findings showed that vascular access was not the independent risk factor for all-cause death in MHD patients (OR=0.921, 95% CI 0.545～1.557, P=0.759); while dialysis vintage (OR=0.976, 95% CI 0.966～0.986, P<0.001), albumin (OR=2.898, 95% CI 1.327～6.330, P=0.008) and chest CT findings (OR=2.060, 95% CI 1.258～3.376, P=0.004) were the independent risk factors for all-cause death in MHD patients.  Conclusions  AVF and TCC as the vascular access types have no direct effect on survival in MHD patients. Active correction of malnutrition, albumin level, lung inflammation as well as chest CT abnormalities may improve the survival of MHD patients

Key words: Maintenance hemodialysis, Autologous arteriovenous fistula, Catheter, Survival rate

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