维持性血液透析患者自体动静脉内瘘失功的影响因素分析

Analysis of the Factors Relating to the Dysfunction in Autogenous Arteriovenous Fistula in Maintenance Hemodialysis Patients

目的:回顾性分析维持性血液透析患者自体动静脉内瘘(AVF)失功的影响因素。方法:以我院血透中心73例首次发生自体AVF失功的患者为内瘘失功组,选取同期自体AVF功能良好的136例维持性血液透析患者为内瘘通畅组,比较两组患者各项临床及生化指标,分别进行单因素分析及logistic回归分析。结果:内瘘失功组和通畅组在年龄、糖尿病、血红蛋白、血清白蛋白、血小板、三酰甘油、血清铁、C反应蛋白(CRP)、血钾、血磷、甲状旁腺激素(PTH)等方面差异存在统计学意义(P<0.05);logistic回归分析显示患有糖尿病(OR=1.551),血清白蛋白(OR=1.061)、三酰甘油(OR=1.275)、血磷(OR=1.580)水平是内瘘失功的危险因素;内瘘失功组的生存分析显示糖尿病患者内瘘的中位生存时间为7个月,非糖尿病患者为27个月,差异有统计学意义(P=0.002);分别进行内瘘失功组和通畅组的组内比较,糖尿病患者与非糖尿病患者在血清白蛋白、三酰甘油、血磷方面差异存在统计学意义(P<0.05)。结论:糖尿病、血清白蛋白、三酰甘油、血磷水平是内瘘失功的危险因素,糖尿病患者内瘘使用时间明显短于非糖尿病患者,其影响因素与血清白蛋白、三酰甘油、血磷水平密切相关。

Objective：To analysis the risk factors for dysfunction in autogenous arteriovenous fistula （ AVF） in maintenance 1 hemodialysis （ MHD） patients. Methods：The fistula dysfunction group studied in this study included 73 MHD patients in hemodial-ysis center of our hospital who had AVF for blood access during hemodialysis and were found to have dysfunction in the AVF for the first time. The fistula patency group included 136 MHD patients whose AVF were well-functioning in the same period as the fistula dysfunction group. Their clinical and biochemical data were collected for analysis of variance and binary logistic regression analysis. Results：There were statistically differences （P〈0. 05） between the two groups in age, diabetes, hemoglobin, serum albumin, plate-lets, triglycerides, serum iron, CRP （ C-reactive protein） , serum potassium, phosphorus and PTH （ parathyroid hormone） . Logistic regression analysis demonstrated that diabetes （OR=1. 551）, serum albumin （OR=1. 061）, triglycerides （OR=1. 275） and serum phosphate （OR=1. 580） were the risk factors for fistula dysfunction. Survival analysis of fistula dysfunction group showed that the median survival of AVF was 7 months in patients with diabetic nephropathy, and was 27 months in patients with non-diabetic ne-phropathy, the difference was significant （P=0. 002）. Comparison carried out within the fistula dysfunction group and unobstructed group, there was significant difference （P〈0. 05） in serum albumin, triglycerides and phosphorus with diabetic and non-diabetic patients. Conclusion：Diabetes, serum albumin, triglycerides and serum phosphate levels are a risk factors for fistula dysfunction. Di-abetic patients using the fistula was significantly shorter than non-diabetic patients, is closely related to its impact with serum albu-min, triglycerides, and blood phosphorus levels.