糖尿病肾病患者自体动静脉内瘘失功的相关因素分析

Factors relating to the dysfunction of autologous arteriovenous fistula in diabetic nephropathy patients

目的研究糖尿病肾病行血液透析患者自体动静脉内瘘失功的影响因素,为今后的临床干预提供理论依据。方法对2012年1月~2014年6月在解放军第四五五医院肾脏科应用自体动静脉内瘘（arterioveneous fistula,AVF）行维持性血液透析患者进行回顾性分析,其中36例原发病为糖尿病肾病患者,并随机选取同时期62例非糖尿病肾病患者作为对照组,将2组患者生化指标、内瘘使用寿命及失功率进行比较,留取2组患者中行AVF重建术时的头静脉血管组织进行HE染色并测量内膜、中膜厚度。结果 1糖尿病肾病组患者透析龄（55.14±6.58）月、首次内瘘使用时间平均为（28.78±6.38）月,明显低于对照组（P〈0.01）。2对2组患者生化指标进行统计,糖尿病肾病组CRP（11.75±1.21）mg/L、PLT（207.00±10.28）×109/L,对照组CRP（5.68±3.16）mg/L、PLT（176.20±8.78）×109/L,2组相比差异具有统计学意义。3超声显示,糖尿病肾病组腕关节上方3cm处头静脉平均血管内径为（2.01±0.11）mm,明显小于对照组（2.38±0.12）mm。4随着内瘘生存时间的延长,各组血管内膜厚度逐渐增加,与非糖尿病肾病组相比,糖尿病肾病患者的内膜增生更为明显。结论糖尿病肾病行血液透析患者自体动静脉内瘘使用寿命相对较短,血管内膜增生明显,C-反应蛋白、血小板水平对内瘘生存时间有显著影响。

Objective To analyze the characteristics of arterioveneous fistula （AVF） in maintenance he- modialysis （MHD） patients with diabetes and its relevant factors. Methods A total of 98 MHD patients including 36 diabetic and 62 non-diabetic patients were enrolled in this study. Information about the time of fistula surgery, the potency of the fistula, and the period of fistula dysfunction were collected and analyzed. Results On the diabetic group, the survival time ofarterioveneous fistula was 55.14＋6.58 month, significantly shorter than that in non-diabetic group. （2）IOne way analysis of variance showed that CRP was 11.75±1.21mg/ L and 5.68±3.16mg/L （P〈0.05）, and PLT was （207.00±10.28）×109/L and （176.20±8.78）× 109/L （P〈0.05） in diabetic group and non-diabetic group, respectively. （3）Vascular ultrasound examination showed that vessel di- ameter was 2.01±0.11mm in diabetic patients narrower than that in non-diabetic group （2.38±0.12mm）. Vascular intima hyperplasia was more prominent in diabetic group. Conclusions The survival time of autolo- gous AVF was relatively shorter in MHD patients with diabetes. Vascular endothelial hyperplasia, and higher CRP and PLT may relate to the shorter survival time of AVF in these patients.