血液透析患者自体动静脉内瘘真性动脉瘤形成的危险因素分析

Risk factors analysis of true aneurysm formation of autogenous arteriovenous fistula in hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者自体动静脉内瘘真性动脉瘤(autogenous arteriovenous fistula aneurysms,AVFAs)形成的危险因素。方法入选2021年6月1日至2021年6月30日在海南省人民医院血液净化中心使用腕部头静脉⁃桡动脉动静脉内瘘(端侧吻合)作为血管通路的MHD患者为研究对象,根据自体动静脉内瘘(autogenous arteriovenous fistula,AVF)是否形成AVFAs分为AVFAs组和非AVFAs组。比较两组患者临床资料和实验室检查结果的差异。采用多因素Logistic回归模型法分析AVFAs形成的危险因素。结果共170例MHD患者入选本研究,男111例(65.3%),女59例(34.7%),年龄为(51.65±12.70)岁,透析龄为(57.03±49.25)个月。AVFAs组33例,非AVFAs组137例,AVFAs发生率为19.4%。与非AVFAs组比较,AVFAs组患者男性占比(χ^(2)=4.934,P=0.026)、血尿酸(t=2.547,P=0.012)和血白蛋白(t=2.122,P=0.010)水平较高,年龄(t=-2.210,P=0.028)、糖尿病肾病占比(χ^(2)=11.788,P=0.001)、收缩压(t=-1.994,P=0.048)和血总胆固醇(t=-2.174,P=0.031)较低,吻合口直径较大(Z=-3.224,P=0.001)。Mantel⁃Haenszel卡方检验结果显示,透析龄(χ^(2)=53.832,OR=0.518,P<0.001)、AVF使用时间(χ^(2)=51.355,OR=0.516,P<0.001)、肱动脉血流量(χ^(2)=25.315,OR=0.331,P<0.001)与AVFAs患病率呈正相关。多因素Logistic回归分析结果显示,男性(OR=10.005,95%CI 1.875~53.394,P=0.007)、透析龄较长(OR=1.341,95%CI 1.104~1.628,P=0.003)、AVF使用时间较长(OR=1.187,95%CI 1.002~1.405,P=0.047)、肱动脉血流量较高(OR=1.002,95%CI 1.000~1.004,P=0.028)和血总胆固醇较低(OR=0.388,95%CI 0.172~0.875,P=0.022)为AVFAs形成的独立危险因素。结论本中心MHD患者AVFAs发生率为19.4%。男性、透析龄长、AVF使用时间长、肱动脉血流量高和血总胆固醇低是AVFAs形成的独立危险因素。

Objective To explore the risk factors of autogenous arteriovenous fistula(AVF)aneurysms(AVFAs)in maintenance hemodialysis(MHD)patients.Methods The patients who used internal arteriovenous fistula(end to side anastomosis)of cephalic vein⁃radial artery at wrist as vascular access in Hainan Provincial People′s Hospital from June 1 to June 30,2021 were selected as the research objects.The patients were divided into AVFAs group and non⁃AVFAs group according to whether AVF formed AVFAs.The clinical data and laboratory examination results between the two groups were compared.Binary logistic regression model was used to analyze the risk factors for the formation of AVFAs.Results A total of 170 MHD patients were enrolled in this study,including 111 males(65.3%)and 59 females(34.7%),with age of(51.65±12.70)years old and dialysis age of(57.03±49.25)months.There were 33 cases in AVFAs group and 137 cases in non⁃AVFAs group.The incidence of AVFAs was 19.4%.Compared with non⁃AVFAs group,the proportion of males(χ^(2)=4.934,P=0.026)and the levels of serum uric acid(t=2.547,P=0.012)and serum albumin(t=2.122,P=0.010)in AVFAs group were higher;The age(t=-2.210,P=0.028),the proportion of diabetes nephropathy(χ^(2)=11.788,P=0.001),systolic blood pressure(t=-1.994,P=0.048)and total cholesterol(t=-2.174,P=0.031)were lower;The diameter of anastomosis was wider(Z=-3.224,P=0.001);Mantel⁃Haenszel chi square test analysis showed that dialysis age(χ^(2)=53.832,OR=0.518,P<0.001),AVF service time(χ^(2)=51.355,OR=0.516,P<0.001),and brachial artery blood flow(χ^(2)=25.315,OR=0.331,P<0.001)were correlated to the formation of AVFAs.The results of multivariate logistic regression analysis showed that males(OR=10.005,95%CI 1.875-53.394,P=0.007),longer dialysis age(OR=1.341,95%CI 1.104-1.628,P=0.003),longer AVF use time(OR=1.187,95%CI 1.002-1.405,P=0.047),higher brachial artery blood flow(OR=1.002,95%CI 1.000-1.004,P=0.028)and lower total cholesterol(OR=0.388,95%CI 0.172-0.875,P=0.022)were the independent risk factors for the formation of AVFAs.Conclusions The incidence of AVFAs in MHD patients is 19.4%.Males,long dialysis age,long AVF use time,high brachial artery blood flow and low total cholesterol level are the independent risk factors for the formation of AVFAs.