中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (11): 649-653.doi: 10.3969/j.issn.1671-4091.2015.11.003

• 临床研究 • 上一篇    下一篇

血液透析患者血管钙化程度与动静脉内瘘失功的关系

陈圳炜   

  1. 广东省深圳市第四人民医院
  • 收稿日期:2015-05-28 修回日期:2015-08-31 出版日期:2015-11-12 发布日期:2015-11-12
  • 通讯作者: 陈圳炜 night807@163.com E-mail:night807@163.com

Impact of vascular calcification on arteriovenous fistula dysfunction in hemodialysis patients

  • Received:2015-05-28 Revised:2015-08-31 Online:2015-11-12 Published:2015-11-12

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摘要： 目的探讨血液透析(HD)患者血管钙化(VC)程度与动静脉内瘘(AVF)失功的关系。方法收集HD 患者行自体AVF 成形术废弃的桡动脉，行钙化染色后分组观察，记录一般情况和检测生化指标，多因素Logistic 回归分析AVF 失功的危险因素。结果110 例HD 患者中17 例(15.45%)存在不同程度的VC。重度钙化组血肌酐(1172.33± 490.75)μmol/L、中位透析时间[72.92(8.40～182.17)]月较非钙化组及轻中度钙化组明显增高(P＜0.05)；AVF 失功与血红蛋白(r=0.480，P=0.000)、血磷(r=0.256, P=0.007)、钙磷乘积(r=0.293，P=0.002)、血肌酐(r=0.309，P=0.001)、透析时间(r=0.266，P=0.005)呈正相关；多因素Logistic 回归分析结果显示，血红蛋白是AVF 失功的发生的危险因素。结论不同程度VC 对1 年内AVF 失功并无影响，长期透析是导致重度VC 的危险因素，AVF 失功与血红蛋白、血磷、钙磷乘积、血肌酐、透析时间呈正相关，血红蛋白是HD患者发生AVF 失功的重要危险因素。

关键词: 血液透析, 血管钙化, 动静脉内瘘

Abstract: Objective To investigate the impact of vascular calcification (VC) on arteriovenous fistula (AVF) dysfunction in hemodialysis (HD) patients. Methods Segments of radial artery were obtained during the arteriovenous fistula operation for HD patients. VC was examined by von Kossa staining. Clinical and biochemical data were collected. Parameters relating to VC were then analyzed by binary logistic regression analysis. Results Among the 110 HD cases, 17 cases (15.45%) had VC in radial arteries of different degrees. Serum creatinine (1172.33±490.75 μmol/L) and dialysis duration [72.92 (8.40~182.170) months] were significantly
higher in patients with severe VC than in those without VC or with mild to moderate VC (P＜0.05). AVF dysfunction was positively correlated with hemoglobin (r=0.408, P=0.000), phosphorus (r=0.256, P=0.007), calcium-phosphorus product (r=0.293, P=0.002), serum creatinine (r=0.309, P=0.001), and dialysis duration
(r=0.266, P=0.005). Binary logistic regression analysis showed that hemoglobin correlated with AVF dysfunction. Conclusions Different degree of VC had no effect on AVF dysfunction in one year. Dialysis duration was the main influential factor for VC in HD patients. Higher hemoglobin correlated closely with AVF
dysfunction.

Key words: Hemodialysis, Vascular calcification, Arteriovenous fistula