手术前腹主动脉钙化积分对新建动静脉内瘘失功的预测价值

Preoperative abdominal aortic calcification score to predict dysfunction of newly-built arteriovenous fistula

目的观察维持性血液透析患者主动脉钙化与新建自体动静脉内瘘初级通畅率的关系,探讨应用主动脉钙化积分预测自体动静脉内瘘功能障碍的可能性。方法选取2015年1月~2018年12月在上海交通大学医学院附属第九人民医院行自体动静脉内瘘并首次进行血液透析的患者,记录其建立动静脉内瘘时的腹主动脉钙化积分(aortic calcification index,ACI),根据ACI结果将患者分成高钙化组和低钙化组,观察3年内2组患者自体动静脉内瘘的初级通畅率。结果共纳入75例患者,其中70例(93.33%)患者存在不同程度的主动脉钙化表现,ACI>10%的高钙化组患者35例。在3年的随访期间,共31例患者发生各种原因的内瘘功能障碍,其中17例血栓形成、10例内瘘狭窄。12、24、36个月时,低钙化组患者的内瘘初级通畅率为92.5%、85.0%、76.9%,高钙化组患者的内瘘初级通畅率为88.6%、68.5%、45.9%,3年后2组患者的内瘘通畅率差异有统计学意义(χ^(2)=7.182,P=0.007)。COX分析显示自体动静脉内瘘的功能障碍发生与ACI相关(HR=5.788,95%CI:1.488~22.514,P=0.011)。结论较高的腹主动脉钙化积分与3年内自体动静脉内瘘功能障碍相关,对于主动脉钙化积分较高的患者需更频繁监测内瘘功能,早期干预,延长内瘘使用寿命。

Objective To observe the relationship between aortic calcification and primary patency rate of autologous internal fistula in maintenance hemodialysis patients,and to explore the possibility of predicting the dysfunction of autologous internal fistula by aortic calcification score.Methods A total of 88 patients who underwent autologous arteriovenous fistula and hemodialysis for the first time in our hospital were selected.Their abdominal aortic calcification index(ACI)at the time of internal fistula surgery was recorded.According to the results of ACI,the patients were divided into high calcification group and low calcification group.The primary patency rate of autologous internal fistula within 3 years was observed in the two groups.Results Seventy patients(93.33%)had different degrees of aortic calcification,including 35 patients in the high calcification group(ACI≥10%).During the 3-year follow-up period,a total of 31 patients developed various internal fistula dysfunctions,including thrombosis in 17 cases and internal fistula stenosis in 10 cases.After 12,24 and 36 months,the primary patency rates of internal fistulas were 92.5%,85%and 76.9%in low calcification group,and were 88.6%,68.5%and 45.9%in high calcification group(χ^(2)=7.182,P=0.007).COX regression showed that autologous internal fistula dysfunction was related to ACI(HR=5.788,95%CI:1.488~22.514,P=0.011).Conclusions Higher ACI is related to the dysfunction of autologous arteriovenous fistula within 3 years.Internal fistula function dysfunction should be monitored and treated earlier in patients with higher ACI to prolong the survival of internal fistula.