维持性血液透析患者自体动静脉内瘘失功的危险因素研究

Risk Factors of Dysfunction in Autogenous Internal Arteriovenous Fistula of Patients with Maintenance Hemodialysis

目的探讨维持性血液透析(MHD)患者自体动静脉内瘘(AVF)失功的危险因素。方法选取2009年1月—2014年9月在广西壮族自治区人民医院行AVF术的MHD患者303例,根据内瘘功能分为失功组(n=97)和通畅组(n=206)。比较两组的一般资料,包括基本情况和实验室指标。影响因素分析采用多因素Logistic回归分析。结果失功组女性比例、糖尿病发生率高于通畅组,年龄及清蛋白、血小板、血磷、甲状旁腺素(PTH)水平亦高于通畅组,体质量、内生肌酐清除率(CCr)、纤维蛋白原水平低于通畅组,差异有统计学意义(P<0.05);而两组头静脉直径、桡动脉直径及总胆固醇、三酰甘油、血红蛋白、D-二聚体、血钙水平间差异无统计学意义(P>0.05)。性别、年龄、血小板水平、血磷、是否合并糖尿病是内瘘功能的独立影响因素(P<0.05)。结论女性、高龄、高血小板水平、高磷血症、合并糖尿病是MHD患者AVF失功的危险因素,可加速内瘘失功。

Objective To discuss the risk factors of dysfunction in autogenous arteriovenous fistula（ AVF） of patients with maintenance hemodialysis（ MHD）.Methods 303 MHD patients who underwent AVF surgery in the People＇ s Hospital of Guangxi Zhuang Autonomous Region from January 2009 to September 2014 were enrolled in this study,and divided into two groups： fistula dysfunction group（ n = 97） and unobstructed group（ n = 206） according to their internal fistula function.Comparisons of general data,including basic situation and laboratory indicators were made between the two groups.Multivariate Logistic regression analysis was used to analyze the influencing factors.Results The proportion of woman and diabetes,age,and levels of albumin,platelet,phosphorus and parathyroid hormone（ PTH） in fistula dysfunction group were significantly higher,while body weight,endogenous creatinine clearance rate（ CCr） and fibrinogen levels were significantly lower than those in unobstructed group（ P〈0.05）.There was no significant difference in the diameter of cephalic vein,diameter of radial artery,and levels of total cholesterol,triglyceride,hemoglobin,D-dimer and blood calcium between the two groups（ P〉0.05）.Gender,age,platelet count,serum phosphorus,and combined with diabetes or not were independent factors of fistula function（ P〈0.05）.Conclusion Women,advanced age,high platelet level,hyperphosphatemia and diabetes are the risk factors of the dysfunction of AVF of patients with MHD,and will accelerate the fistula dysfunction.