血液透析患者自体动静脉内瘘失功的相关因素分析

Analysis on related factors of dysfunction of autologous arteriovenous fistula in hemodialysis patients

目的探讨自体动静脉内瘘(AVF)失功的相关因素。方法回顾性分析以AVF作为血管通路行血液透析(HD)的112例患者,其中男性80例,女性32例,平均年龄(54.505±14.005)岁,透析龄6~60个月,根据内瘘是否出现失功分为通畅组和失功组,对原发病进行分析,观察糖尿病肾病与非糖尿病肾病在2组中的比例;同时观察2组患者的一般检验情况:低密度脂蛋白(LDH)、超敏-C反应蛋白(hs-CRP)、血小板(PLT)、血色素(Hgb)、血白蛋白(Alb)及全段甲状旁腺激素(i-PTH),AVF的各项指标:动脉平均直径、静脉平均直径、内瘘使用时间等,分析这些指标在自体动静脉内瘘失功中的影响。结果失功组中糖尿病肾病比例明显高于通畅组,差异具有统计学意义(P<0.05);失功组中血i-PTH、Hgb及Alb明显高于通畅组,差异有统计学意义(P<0.05);而血LDH、hs-CRP、PLT、动脉及静脉平均直径、内瘘使用时间等指标在2组间无显著性差异(P>0.05)。结论血液透析患者中,原发病为糖尿病肾病是AVF失功的重要因素;研究显示,相对较高水平的血色素、血白蛋白和高水平的全段甲状旁腺激素均是自体动静脉内瘘失功的重要影响因素,应积极制订干预方案,减少自体动静脉内瘘的失功。

Objective To discuss and analyze the related factors of the dysfunction of autologous arteriovenous fistula （AVF）. Methods 112 patients with vascular access hemodialysis （HD） who received hemodialysis for six to sixty months in AVF were retrospectively analyzed. Patients were divided into unobstructed group and unresponsive group. The primary disease was analyzed, and the proportion of diabetic nephropathy and non - diabetic nephropathy was observed in the two groups. The general condition such as LDH, Hs - CRP, PLT, Alb, and i - PTH and indexes of AVF such as diameter of radial artery, head vein diameter, fistula use time that relat- ed to dysfunction of AVF were observed. Results The proportion of diabetic nephropathy was significantly higher in the failure group than that in the patency group （P 〈 0.05 ） ; The levels of i - PTH, Hgb and Alb in the failure group were significantly higher than those in the patency group （ P 〈 0.05） ; The factors such as LDH, hs - CRP, PLT, diameter of radial artery and cephalic vein, the time of fis- tula and other factors had no significant difference （P 〉 0.05）. Conclusion Among the hemodialysis patients, the primary diabetic ne- phropathy is an important factor in the failure of fistula. High levels of hemoglobin, serum albumin and high levels of whole parathyroid hormone are important factors relating to failure in autologous arteriovenous fistula. These factors should be actively prevention and to reduce the loss of autologous arteriovenous fistula.