中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (09): 706-709.doi: 10.3969/j.issn.1671-4091.2023.09.016

• 血管通路 • 上一篇    下一篇

终末期肾病患者腹主动脉钙化与自体动静脉内瘘成熟不良的关系

李 婷   王秀峰    赵玉杰    关林萌    王 辉    邵晓琳    杨 军   

  1. 453100 卫辉，1新乡医学院第一附属医院肾脏病医院血液净化室
    453100 卫辉，2新乡医学院第一附属医院血液内科
  • 收稿日期:2023-04-14 修回日期:2023-07-05 出版日期:2023-09-12 发布日期:2023-09-12
  • 通讯作者: 杨军 E-mail:changting2010@126.com
  • 基金资助:
    河南省医学科技攻关计划项目(LHGJ20220590)；新乡医学院第一附属医院青年培育基金项目(QN-2020-B06)

Association between abdominal aortic calcification and immaturation of autogenousarteriovenous fistula in patients with end-stage renal disease

LI Ting, WANG Xiu-feng, ZHAO Yu-jie, GUAN Lin-meng, WANG Hui, SHAO Xiao-lin, YANG Jun   

  1. Blood Purification Center of Kidney Disease Hospital, and 2Department of Hematology, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
  • Received:2023-04-14 Revised:2023-07-05 Online:2023-09-12 Published:2023-09-12
  • Contact: 453100 卫辉，1新乡医学院第一附属医院肾脏病医院血液净化室 E-mail:changting2010@126.com

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摘要： 目的 探讨终末期肾病患者腹主动脉钙化(abdominal aortic calcification,AAC)与自体动静脉内瘘(arteriovenous fistula,AVF)成熟不良的相关性，及自体动静脉内瘘成熟不良的影响因素。 方法 收集2021年10月—2022年10月在新乡医学院第一附属医院肾脏病医院首次行AVF成形术并定期进行随访的慢性肾脏病(chronic kidney disease,CKD)5期患者，收集患者的一般资料、血液学资料、AAC评分(AAC score，AACs)情况、手术前和手术后彩超检查资料。根据内瘘术后物理检查情况、临床使用、手术后彩超数据将患者分为内瘘成熟组及未成熟组，对比2组资料之间的差异。多因素Logistic回归分析法分析AVF成熟不良的影响因素。 结果 本研究共纳入160例患者，内瘘成熟组(n=118)与未成熟组(n=42)患者在年龄(t=4.078，P＜0.001)、糖尿病病史(χ 2=4.050，P=0.044)、AACs(t=7.056，P＜0.001)、全段甲状旁腺激素(iPTH)(t=2.151，P=0.035)等方面差异有统计学意义。单因素Logistic回归分析结果显示年龄(OR=1.102，95% CI:1.042～1.166，P=0.001)、糖尿病病史(OR=2.807，95% CI:1.010～7.803，P=0.048)、AACs(OR=1.559，95% CI:1.269～1.915，P＜0.001)、iPTH(OR=1.002，95% CI:1.000～1.005，P=0.040)均与内瘘成熟不良相关，多因素Logistic回归分析结果显示年龄(OR=1.073，95% CI:1.007～1.142，P=0.030)、AACs(OR=1.478，95% CI:1.197～1.825，P＜0.001)是CKD 5期患者发生AVF成熟不良的独立影响因素。 结论 年龄和AACs是动静脉内瘘成熟不良的独立影响因素，在内瘘评估中应考虑上述因素对内瘘成熟的影响。

关键词: 血液透析, 动静脉内瘘, 成熟, 腹主动脉, 血管钙化

Abstract: Objective  To explore the relationship between abdominal aortic calcification (AAC) and poor maturation of autologous arteriovenous fistula (AVF), and the influencing factors for poor maturation of AVF.  Methods  Patients with chronic kidney disease (CKD) at stage 5 and undergoing AVF construction for the first time at the First Affiliated Hospital of Xinxiang Medical university from October 2021 to October 2022 were enrolled in this study. Their general clinical data, hematological findings, AAC score, and preoperative and postoperative ultrasound examination results were collected. Patients were then divided into immature group and mature group according to physical examination, clinical use, and color Doppler ultrasound results after AVF surgery. Multivariate logistic regression was used to analyze the influencing factors for poor maturation of AVF.  Results  A total of 160 patients were included, with the age of 49.78±14.17 years old and 67.5% of males. There were statistically significant differences in age (t=4.078, P＜0.001), diabetes history (χ 2=4.050, P=0.044), AAC score (t=7.056, P＜0.001) and iPTH (t=2.151, P=0.035) between the two groups. Univariate logistic regression showed that age (OR=1.102, 95% CI 1.042～1.166, P=0.001), diabetes history (OR=2.807, 95% CI 1.010～7.803, P=0.048), AAC score (OR=1.559, 95% CI 1.269～1.915, P＜0.001) and iPTH (OR=1.002, 95% CI 1.000～1.005, P=0.040) were associated with poor maturation of AVF. Multivariate logistic regression showed that age (OR=1.073, 95% CI 1.007～1.142, P=0.030) and AAC score (OR=1.478, 95% CI 1.197～1.825, P＜0.001) were the independent influencing factors for poor maturation of AVF in CKD patients at stage 5.  Conclusions  Our study demonstrates that age and AAC score were the independent influencing factors for poor maturation of AVF. Therefore, age and AAC score should be considered in the evaluation of AVF maturation after operation.

Key words: Hemodialysis, Arteriovenous fistula, Maturation, Abdominal aorta, Vascular calcification

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