HIV血液透析患者深静脉血栓形成的危险因素分析

Analysis of Risk Factors of Deep Vein Thrombosis in HIV Hemodialysis Patients

目的分析艾滋病(HIV)患者合并肾衰竭需急诊血液透析于股静脉临时中心静脉导管置入术后发生深静脉血栓栓塞的风险及危险因素,为早期发现及时采取临床防治措施提供参考。方法选择2015年6月~2018年5月贵州省各地就诊于贵阳市公共卫生救治中心需接受血液透析首次留置股静脉临时中心静脉导管的66例HIV患者的临床资料,将发生深静脉血栓(DVT)的26例作为HIVDVT组,未发生深静脉血栓者的40例设为HIV非DVT组,同期选取非HIV感染的血液透析患者93例作为对照组;分析合并HIV感染的血液透析患者发生DVT的风险及相关危险因素。结果HIV患者DVT风险为39.39%,高于对照组的12.90%,差异有统计学意义(P<0.05);且导管留置第9天时易发生DVT。HIVDVT组与HIV非DVT组年龄、体重指数、置管前水肿、抗反转录病毒治疗(ART)、白细胞、红细胞、血红蛋白、血小板计数、凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、尿素、血肌酐、β2-微球蛋白、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、载脂蛋白A比较,差异无统计学意义(P>0.05),两组ART、CD4^+T淋巴细胞计数、D-二聚体、载脂蛋白B、置管天数比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,CD4^+T淋巴细胞计数、D-二聚体是HIV血透患者股静脉临时中心静脉导管留置后发生DVT的独立危险因素,载脂蛋白B为独立保护因素。结论与非HIV感染的血液透析患者相比,HIV血透患者中心静脉导管留置后易发生DVT,其中CD4^+T淋巴细胞计数、D-二聚体为其独立危险因素,载脂蛋白B为独立保护因素,对此类患者需早期干预,降低其DVT发生率。

Objective To analyze the risk and risk factors of deep vein thromboembolism in patients with AIDS(HIV)complicated with renal failure requiring emergency hemodialysis after femoral vein temporary central venous catheter placement,and provide reference for early detection and timely clinical prevention and treatment measures.Methods The data of 66 HIV patients who received hemodialysis in Guiyang Public Health Clinical Center from June 2015 to May 2018 were reviewed.26 patients of deep venous thrombosis(DVT)were included inHIV DVT group,and the other 40 cases were selected asHIV nonDVT group.At the same time,93 hemodialysis patients for non HIV infectionwere selected as control group.To analyze the risk of DVT and related risk factors in hemodialysis patients with HIV infection.Results The risk of DVT in HIV patients was 39.39%,which was higher than 12.90% in the control group,the difference was statistically significant(P<0.05);and DVT was prone to occur on the 9th day of catheter indwelling.HIVDVT group and HIV non-DVT group age,body mass index,pre-intubation edema,antiretroviral therapy(ART),white blood cells,red blood cells,hemoglobin,platelet count,prothrombin time,activated partial thromboplastin time,fibrin,there was no statistically significant difference between the original,urea,blood creatinine,β2-microglobulin,total cholesterol,triglycerides,low-density lipoprotein,high-density lipoprotein,and apolipoprotein A(P>0.05).The two groups of ART,CD4^+T lymphocyte count,D-dimer,apolipoprotein B,and the number of days of catheterization,the difference was statistically significant(P<0.05);Multivariate Logistic regression analysis showed that CD4^+T lymphocyte count and D-dimer were independent risk factors for DVT after femoral vein indwelling temporary central venous catheter in HIV hemodialysis patients,and apolipoprotein B was an independent protective factor.Conclusion Compared with non-HIV-infected hemodialysis patients,HIV hemodialysis patients are more likely to develop DVT after central venous catheter indwelling.CD4^+T lymphocyte count and D-dimer are independent risk factors,and apolipoprotein B is independent.Protective factors,such patients need early intervention to reduce the incidence of DVT.