自体动静脉内瘘血栓危险因素的Meta分析

Systematic review and meta analysis of the risk factors for thrombosis in arteriovenous fistula

目的明确血液透析患者发生自体动静脉内瘘血栓(arteriovenous fistulas thrombus,AVFT)的危险因素,为预防血液透析患者AVFT的发生提供依据。方法计算机检索Cochrane Library、PubMed、Embase、Web Of Science、中国知网、万方数据库、维普数据库和中国生物医学文献数据库,搜集建库至2020年7月关于血液透析患者发生自体动静脉内瘘脉血栓危险因素的文献,利用RevMan 5.3软件进行Meta分析。结果共纳入20篇文献,包括49项相关危险因素。Meta分析结果,各危险因素的合并OR值(95%CI,P)分别为:C-反应蛋白1.16(1.08~1.26,P=0.001)、年龄1.02(1.01~1.03,P=0.001)、收缩压1.12(1.07~1.19,P<0.001)、糖尿病1.67(1.33~2.11,P<0.001)、女性2.50(1.83~3.42,P<0.001)、低血压5.57(2.88~10.75,P<0.001)。结论C-反应蛋白、高龄、收缩压、糖尿病、女性、低血压是血液透析自体动静脉内瘘血栓的危险因素,应针对血液透析人群中存在的AVFT的可控危险因素进行早期干预。

Objective To identify the risk factors for autologous arteriovenous fistula thrombosis(AVFT)in hemodialysis patients,and to explore the clinical data useful for preventing AVFT in hemodialysis patients.Methods We searched Cochrane Library,PubMed,Embase,Web of Science,CNKI,Wanfang Database,Weipu Database and China Biomedical Literature Databases before July 2020 about the risk factors for thrombosis in autologous arteriovenous fistula in hemodialysis patients.The searched information was analyzed by the RevMan 5.3 software.Results A total of 20 articles were included,containing 49 related risk factors.Meta analysis showed that the combined OR values of all risk factors included C-reactive protein 1.16(95%CI:1.08~1.26,P=0.001),age 1.02(95%CI:1.01~1.03,P=0.001),systolic blood pressure 1.12(95%CI:1.07~1.19,P<0.001),diabetes mellitus 1.67(95%CI:1.33~2.11,P<0.001),female 2.50(95%CI:1.83~3.42,P<0.001),and hypotension 5.57(95%CI:2.88~10.75,P<0.001).Conclusion C-reactive protein,age,systolic blood pressure,diabetes mellitus,female and hypotension were the risk factors for thrombosis in autologous arteriovenous fistula in hemodialysis patients.Early intervention to the controllable risk factors of AVFT should be emphasized in hemodialysis patients.