中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (04): 330-334.doi: 10.3969/j.issn.1671-4091.2026.04.011

• 血管通路 • 上一篇    下一篇

维持性血液透析患者血管通路血栓危险因素的系统评价与Meta分析

瞿嘉园   李丹阳  郭美倩   史子月   邓小梅     王培席   

  1. 475001 郑州，1河南大学护理与健康学院
    518000 深圳，2北京大学深圳医院综合病区
    511400 广州，3广州医科大学附属番禺中心医院重症医学科
  • 收稿日期:2025-07-03 修回日期:2025-12-30 出版日期:2026-04-12 发布日期:2026-04-12
  • 通讯作者: 邓小梅 E-mail:dxmarilyn@163.com

Systematic review and meta-analysis of risk factors for vascular access thrombosis in patients on maintenance hemodialysis

QU Jia-yuan, LI Dan-yang, GUO Mei-qian, SHI Zi-yue, DENG Xiao-mei, WANG Pei-xi   

  1. School of Nursing and Health, Henan University, Zhengzhou 475001, China; 2Department of Comprehensive Ward, Peking University Shenzhen Hospital, Shenzhen 518000, China; 3Department of Intensive Care Unit, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou 511400, China
  • Received:2025-07-03 Revised:2025-12-30 Online:2026-04-12 Published:2026-04-12
  • Contact: 518000 深圳，2北京大学深圳医院综合病区 E-mail:dxmarilyn@163.com

摘要： 目的 系统评价维持性血液透析患者血管通路血栓形成(vascular access thrombosis,VAT)的相关危险因素，为临床干预提供循证依据。 方法 系统检索PubMed、Scopus、Ovid、Web of Science、Cochrane Library、中国知网、万方、维普、CBM及读秀数据库中关于VAT相关危险因素的病例对照研究和队列研究，检索时间时限为建库至2025年2月。采用Stata 17.0软件进行Meta分析。 结果 共纳入17项研究，文献质量评分均≥7分。Meta分析显示女性(OR=1.481,95%CI:1.177～1.862,P＜0.001)、血管通路类型为移植物动静脉内瘘(OR=2.773,95%CI:1.573～4.889,P＜0.001)、糖尿病(OR=2.163,95%CI:1.451～3.225,P＜0.001)、透析中低血压(OR=2.897,95%CI:2.146～3.912,P＜0.001)、平均血小板体积升高(OR=1.587,95%CI:1.331～1.891,P＜0.001)、TNF-α浓度升高(OR=1.132,95%CI:1.062～1.206,P＜0.001)增加VAT风险；血红蛋白浓度升高(OR=0.867,95%CI:0.789～0.952,P＜0.050)与抗血小板药物治疗(OR=0.669,95%CI:0.567～0.790,P＜0.050)可以显著降低VAT风险。 结论 女性、移植物动静脉内瘘、糖尿病、透析中低血压、平均血小板体积升高和TNF-α浓度升高为VAT的危险因素，血红蛋白浓度升高和抗血小板药物治疗是保护因素。研究存在一定的异质性，需进一步验证不同人群中的适用性。

关键词: 维持性血液透析, 血管通路血栓, 危险因素

Abstract: Objective  To systematically evaluate the risk factors for vascular access thrombosis (VAT) in patients undergoing maintenance hemodialysis, and to provide evidence-based guidance for clinical intervention.  Methods  A comprehensive literature search was conducted in PubMed, Scopus, Ovid, Web of Science, Cochrane Library, CNKI, Wan Fang, VIP, CBM and Duxiu, covering case-control and cohort studies on VAT-related risk factors from database inception to February, 2025. Meta-analysis was performed using Stata version 17.0.  Results  A total of 17 studies were included, all with a quality assessment score of ≥7. Meta-analysis revealed that female (OR=1.481, 95% CI: 1.177～1.862, P＜0.001), graft arteriovenous fistula (OR=2.773, 95% CI: 1.573～4.889, P＜0.001), diabetes mellitus (OR=2.163, 95% CI: 1.451～3.225, P＜0.001), intradialytic hypotension (OR=2.897, 95% CI: 2.146～3.912, P＜0.001), elevated mean platelet volume (OR=1.587, 95% CI: 1.331～1.891, P＜0.001), and increased TNF-α level (OR=1.132, 95% CI: 1.062～1.206, P＜0.001) were associated with an increased risk of VAT. In contrast, higher hemoglobin level (OR=0.867, 95% CI:0.789～0.952, P＜0.050) and antiplatelet therapy (OR=0.669, 95% CI: 0.567～0.790, P＜0.050) were associated with a reduced risk of VAT.  Conclusion   Female, prosthetic graft, diabetes, intradialytic hypotension, increased mean platelet volume, and elevated TNF-α level are the risk factors for VAT, while higher hemoglobin level and antiplatelet therapy are the protective factors for VAT. Given the observed heterogeneity among the included studies, further research is warranted to confirm these findings across different patient groups.

Key words: Maintenance hemodialysis, Vascular access thrombosis, Risk factor

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