维持性血液透析患者自体动静脉内瘘失功的影响因素

Influence factors of autologous arteriovenous fistula failure in patients undergoing maintenance hemodialysis

目的探讨维持性血液透析患者自体动静脉内瘘(AVF)失功的影响因素。方法选取2017年11月至2018年11月于吉林省吉林市化工医院行维持性血液透析的患者186例,依据AVF功能分为失功组(40例)和通畅组(146例)。记录患者临床资料及检测相关指标,采用多因素Logistic回归分析AVF失功的影响因素。结果失功组女性比例、年龄、糖尿病比例高于通畅组,体质量低于通畅组,血清白蛋白、血小板计数、血磷、甲状旁腺激素水平高于通畅组,内生肌酐清除率、纤维蛋白原水平低于通畅组,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,女性(比值比=1.73,95%置信区间:1.18~2.39,P=0.022)、年龄>60岁(比值比=1.25,95%置信区间:1.08~1.76,P=0.003)、血小板计数>200×10^9/L(比值比=1.14,95%置信区间:1.02~1.39,P=0.045)、血磷>2.00 mmol/L(比值比=1.79,95%置信区间:1.21~2.55,P<0.001)、合并糖尿病(比值比=2.40,95%置信区间:1.59~3.26,P<0.001)是AVF失功的危险因素。结论女性、高龄(>60岁)、血小板计数升高(>200×10^9/L)、血磷升高(>2.00 mmol/L)、合并糖尿病是维持性血液透析患者AVF失功的危险因素。

Objective To investigate the influence factors of autologous arteriovenous fistula(AVF)failure in patients undergoing maintenance hemodialysis.Methods From November 2017 to November 2018,186 patients undergoing maintenance hemodialysis in Jinlin Chemical Hospital were enrolled.According to the patency of AVF,the patients were divided into AVF failure group(40 cases)and normal group(146 cases).The factors causing AVF failure were analyzed by multivariate logistic regression.Results AVF failure group had more female,older age,more diabetes,lower body weight,higher serum albumin,higher platelet count,higher inorganic phosphorus and parathyroid hormone,lower creatinine clearance and lower fibrinogen level(all P<0.05).Multivariate logistic regression analysis showed that female(odds ratio=1.73,95%confidence interval:1.18-2.39,P=0.022),age>60 years(odds ratio=1.25,95%confidence interval:1.08-1.76,P=0.003),platelet count>200×10^9/L(odds ratio=1.14,95%confidence interval:1.02-1.39,P=0.045),serum inorganic phosphorus>2.00 mmol/L(odds ratio=1.79,95%confidence interval:1.21-2.55,P<0.001)and diabetes(odds ratio=2.40,95%confidence interval:1.59-3.26,P<0.001)were risk factors of AVF failure.Conclusion Female,advanced age(>60 years old),high platelet count(>200×10^9/L),high serum inorganic phosphorus level(>2.00 mmol/L)and diabetes are risk factors of AVF failure in patients undergoing maintenance hemodialysis.