维持性血液透析患者自体动静脉内瘘早期失功的影响因素分析

The influencing factors for early failure of arteriovenous fistula in maintenance hemodialysis patients

目的了解维持性血液透析(maintenance hemodialysis,MHD)患者自体动静脉内瘘(arteriovenous fistula,AVF)的早期失功情况,并探讨MHD患者1年、2年AVF失功率的影响因素。方法选取2017年1月—2020年12月上海交通大学附属第九人民医院肾内科收治的首次行AVF成形术的终末期肾病(end stage renal disease,ESRD)患者128例,并观察这些患者2年内临床数据,根据AVF失功诊断标准及AVF通畅时间,将纳入患者分为1年内失功组、1年内非失功组、2年内失功组和2年内非失功组。回顾性探究不同时间失功组及非失功组各项临床资料的差异。结果多因素COX回归显示:较低血红蛋白水平(OR=4.729,95%CI:1.108~20.188,P=0.036)、较低血小板水平(OR=0.980,95%CI:0.967~0.993,P=0.003)、较低血糖水平(OR=0.665,95%CI:0.449~0.986,P=0.042)、较高年龄(OR=1.051,95%CI1.001~1.102,P=0.044)、女性(OR=6.468,95%CI:1.458~28.689,P=0.014)是AVF 1年内失功的独立危险因素;较高年龄(OR=1.042,95%CI:1.001~1.085,P=0.046)、较低血红蛋白(OR=0.948,95%CI:0.912~0.986,P=0.007)水平、较低血小板水平(OR=0.986,95%CI:0.976~0.997,P=0.009)、较低血糖水平(OR=0.632,95%CI:0.419~0.953,P=0.029)是2年内AVF失功的独立风险因素。Kaplan-Meier生存曲线及Log-rank检验显示年龄≥60岁的患者AVF通畅时间明显短于<60岁的患者(χ^(2)=6.253,P=0.012);女性患者AVF通畅时间明显短于男性患者(χ^(2)=9.387,P=0.002)。结论初次建立AVF时,女性、较高年龄、较低血红蛋白水平、较低血小板水平、较低血糖水平是ESRD患者AVF早期失功的危险因素。

Objective To explore the risk factors for early dysfunction of arteriovenous fistula(AVF)in maintenance hemodialysis(MHD)patients.Methods A total of 128 patients who underwent the first AVF creation surgery from January 2017 to February 2020 in the single center were enrolled in this study.Based on the diagnosis criteria of AVF failure and the AVF patency duration,patients were divided into one-year failure group,one-year non-failure group,2-year failure group and 2-year non-failure group.The differences in clinical data between failure groups and non-failure groups were retrospectively analyzed.Results Multivariate COX regression revealed that lower hemoglobin(OR=4.729,95%CI:1.108~20.188,P=0.036),lower platelet(OR=0.980,95%CI:0.967~0.993,P=0.003),lower blood glucose(OR=0.665,95%CI:0.449~0.986,P=0.042),older age(OR=1.051,95%CI:1.001~1.102,P=0.044)and female(OR=6.468,95%CI:1.458~28.689,P=0.014)were the risk factors for AVF failure in one year;older age(OR=1.042,95%CI:1.001~1.085,P=0.046),lower hemoglobin(OR=0.948,95%CI:0.912~0.986,P=0.007),lower platelet(OR=0.986,95%CI:0.976~0.997,P=0.009)and lower blood glucose(OR=0.632,95%CI:0.419~0.953,P=0.029)were the risk factors for AVF failure in two years.Kaplan-Meier survival curve demonstrated that the AVF patency duration was significantly shorter in patients over 60 years old than in those<60 years old(log-rank,c2=6.253,P=0.012),and was shorter in females than in males(log-rank,c2=9.387,P=0.002).Conclusion Older age,female,lower hemoglobin,lower platelet,and lower blood glucose were the risk factors for early failure of AVF in MHD patients.