血液透析患者人工血管移植物内瘘功能障碍的影响因素分析

Analysis of influencing factors for arteriovenous graft dysfunction in hemodialysis patients

目的探讨血液透析(hemodialysis,HD)患者人工血管移植物内瘘(arteriovenous graft,AVG)功能障碍的影响因素,为预测风险、延长使用时间提供依据。方法回顾性分析南方医科大学南方医院血管与介入科2013年1月至2018年9月期间行AVG建立手术患者的临床与随访资料,通过统计学方法分析AVG功能障碍的影响因素。结果共纳入139例患者,其中男58例(41.7%);中位年龄57岁;24个月内83例(59.7%)出现AVG功能障碍。Kaplan-Meier生存分析结果显示,在AVG建立后6、12和24个月,其初级通畅率分别为76.1%、56.8%和38.5%。Kaplan-Meier生存分析结果显示,术后24个月,老年(年龄>65岁)患者AVG功能障碍的发生风险显著高于≤65岁患者(Log-rank χ^(2)=7.632,P=0.006);平均血小板体积(mean platelet volume,MPV)>10.1 fl患者AVG功能障碍的发生风险显著高于MPV≤10.1 fl患者(Log-rank χ^(2)=19.910,P<0.001);血小板分布宽度(platelet distribution width,PDW)>11.4 fl患者AVG功能障碍的发生风险显著高于PDW≤11.4 fl患者(Log-rank χ^(2)=35.410,P<0.001);大型血小板比例(platelet-larger cell ratio,P-LCR)>24.8%患者AVG功能障碍的发生率显著高于P-LCR≤24.8%患者(Log-rank χ^(2)=7.181,P=0.007)。多因素Cox风险回归分析结果显示,高MPV(MPV>10.1 fl,HR=6.501,95%CI 1.916~22.054,P=0.003)、高PDW(PDW>11.4 fl,HR=3.625,95%CI 1.957~6.714,P<0.001)及低P-LCR(P-LCR>24.8%,HR=0.145,95%CI 0.045~0.470,P=0.001)为AVG功能障碍的独立影响因素。通过以上因素建立函数模型对预测HD患者AVG功能障碍的风险程度有一定价值(似然比检验χ^(2)=49.360,P<0.001)。结论HD患者AVG功能障碍的影响因素较多,其中MPV、PDW、P-LCR水平可能是造成AVG功能障碍的影响因素,术前或术后复诊综合评估这些因素对预防AVG功能障碍有一定的指导意义。

Objective To explore the influencing factors of arteriovenous graft(AVG)dysfunction in hemodialysis(HD)patients,and provide a basis for predicting the risk of dysfunction and prolonging the service time.Methods Retrospective analysis was performed on the clinical and follow-up data of patients who underwent AVG surgery in Department of Vascular and Interventional Surgery,Nanfang Hospital,Southern Medical University from January 2013 to September 2018.The factors of AVG dysfunction were determined by statistical methods.Results A total of 139 patients were enrolled,including 58 males(41.7%);the median age was 57;in which 83 patients(59.7%)developed AVG dysfunction within 24 months.Kaplan-Meier survival analysis showed that the primary patency rates were 76.1%,56.8%,and 38.5% at 6,12,and 24 months after the establishment of AVG.The results of Kaplan-Meier survival analysis showed that at 24 months after surgery,the risk of AVG dysfunction in elderly patients(>65 years old)was significantly higher than that of patients≤65 years old(Log-rankχ^(2)=7.632,P=0.006);the risk of AVG dysfunction in patients with mean platelet volume(MPV)>10.1 fl was significantly higher than that of patients with MPV≤10.1 fl(Log-rank χ^(2)=19.910,P<0.001);the risk of AVG dysfunction in patients with platelet distribution width(PDW)>11.4 fl was significantly higher than that of patients with PDW≤11.4 fl(Log-rank χ^(2)=35.410,P<0.001);the risk of AVG dysfunction in patients with platelet-larger cell ratio(P-LCR)>24.8% was significantly higher than that of patients with P-LCR≤24.8%(Log-rank χ^(2)=7.181,P=0.007).Multivariate Cox proportional risk regression analysis showed that high MPV(MPV>10.1 fl,HR=6.501,95%CI 1.916-22.054,P=0.003),high PDW(PDW>11.4 fl,HR=3.625,95%CI 1.957-6.714,P<0.001)and low P-LCR(P-LCR>24.8%,HR=0.145,95%CI 0.045-0.470,P=0.001)were independent influencing factors for AVG dysfunction.The establishment of a functional prediction equation based on the above factors had a certain value in predicting the risk of AVG dysfunction in HD patients(likelihood ratio test:χ^(2)=49.360,P<0.001).Conclusions There are multiple factors that affect AVG dysfunction in HD patients,among which MPV,PDW and P-LCR levels may be the influencing factors for AVG dysfunction.Preoperative examination or postoperative comprehensive review of these factors during the follow-up period has certain directive significance for the prevention of AVG dysfunction.