影响终末期肾脏病患者自体动静脉内瘘成熟因素分析

Analysis of parameters affecting autologous arteriovenous fistula functional maturation in a population of patients with end-stage renal disease

目的研究影响终末期肾脏病患者自体动静脉内瘘成熟的因素。方法回顾性分析2010年1月至2015年12月收治的终末期肾脏病行动静脉内瘘手术的335例连续患者的资料。筛选影响终末期肾脏病患者自体动静脉内瘘成熟的因素。结果动静脉内瘘成熟率为78，14％（218／279）。糖尿病患者内瘘成熟率68．33％（82／120），低于无糖尿病患者的85．54％（136／159），低蛋白血症患者内瘘成熟率62．26％（33／53），低于无低蛋白血症患者的81．86％（185／226），差异有统计学意义（χ^2=11．844、9．648，P〈0．01），是促进内瘘成熟的危险因素（OR=6．003、8．476）。围手术期钙通道阻滞剂使用的患者内瘘成熟率87．10％（81／93），高于未使用患者的73．66％（137／186），差异有统计学意义（χ^2=6．556，P〈0．05），是促进内瘘成熟的保护因素（OR=O．086）。结论糖尿病和低蛋白血症与动静脉内瘘不能成熟高度相关。围手术期钙通道阻滞剂使用可促进内瘘成熟。这对指导临床干预具有重要意义。

Objective To investigate demographic factors implicated in the functional maturation of autologous arteriovenous fistula in a population of patients with end-stage renal disease. Methods The data of 335 consecutive patients with end-stage renal disease who were performed autologous arteriovenous fistula from January 2010 to December 2015 were analyzed retrospectively. The parameters affecting autologous arteriovenous fistula functional maturation were screened. Results Overall arteriovenous fistula functional maturation rate was 78.14% （218/279）. The arteriovenous fistula functional maturation rate was 68.33% （82/120） in diabetes and 85.54%（156/159） in non-diabetes, and there was significant difference （χ^2=11.844, P〈0.01）. The arteriovenous fistula functional maturation rate was 62.26% （33/53） in hypoproteinemia and 81.86% （185/226） in non-hypoproteinemia, and there was significant difference （χ^2=9.648, P〈0.01）. Diabetes and hypoproteinemia were the risk factors to promote functional maturation （OR=6.003, 8.476）. The arteriovenous fistula functional maturation rate was 87.10% （81/93） in calcium channel blockers using and 73.66%（137/186） in non-calcium channel blockers using, and there was significant difference （χ^2=6.556, P 〈 0.05）. Calcium channel blockers was the protective factor for promoting functional maturation （OR=0.086）. Conclusions Diabetes and hypoproteinemia are found to be associated with functional non-maturation, while calcium channel-blocker agents are associated with better functional maturation.