糖尿病肾病血液透析患者动静脉内瘘狭窄相关因素分析

Analysis of the related factors inducing stenosis of native arteriovenous fistula (AVF) in hemodialysis patients with diabetic nephropathy

目的探讨糖尿病肾病维持性血液透析患者动静脉内瘘狭窄的影响因素。方法选择2009年1月至2014年12月于广州市第一人民医院接受自体动静脉内瘘维持性血液透析治疗的241例糖尿病肾病患者,对其病历资料进行回顾性分析,分为非血栓性内瘘狭窄组（内瘘狭窄组,n=60）和无内瘘狭窄组（非狭窄组,n=181）;比较两组患者一般情况、血生化指标及血管病理的差别,并进行Logistic回归分析。结果内瘘狭窄组患者年龄、糖尿病病程、Cˉ反应蛋白水平均明显高于非狭窄组（P〈0.05）,内瘘狭窄组中前臂头静脉内径较小（2.5~3.0 mm）的患者比例明显高于非狭窄组,差异有统计学意义（P〈0.05）;Logistic回归分析显示术前前臂头静脉内径偏小（OR=0.083）是术后自体动静脉内瘘狭窄的危险因素。结论年龄、糖尿病病程、Cˉ反应蛋白、术前前臂头静脉内径是影响糖尿病肾病患者自体动静脉内瘘狭窄的重要因素,其中术前前臂头静脉内径的评估尤为重要。

Objective To investigate the influential factors relating to stenosis of arteriovenous fistula（AVF）in hemodialysis（HD）patients with diabetic nephropathy. Methods From January 2009 to December 2014,241 diabetic nephropathy patients undergoing hemodialysis with native AVF were divided into two groups：non-thrombotic AVF stenosed group（60 cases）and AVF non-stenosed group（181 cases）.Patients＇ general situation,blood biochemical index and vascular pathology were observed. Logistic regression analysis was performed. Results Age,duration of diabetes,and c-reactive protein in nonthrombotic AVF stenosed group were significantly higher than those of AVF non-stenosed group（P0.05）.The proportion of patients of the non-thrombotic AVF stenosed group with forearm cephalic vein smaller diameter（2.5~3.0 mm）was significantly higher than of AVF non-stenosed group（P0.05）. Logistic regression analysis showed that preoperative forearm cephalic vein diameter（OR=0.083）was a risk factor causing postoperative arteriovenous fistula stenosis. Conclusion Postoperative arteriovenous fistula stenosis is associated with age, duration of diabetes,C-reactive protein level and preoperative forearm cephalic vein diameter;especially,the preoperative assessment of forearm cephalic vein diameter is important.