维持性血液透析患者移植物动静脉内瘘的生存分析

Survival analysis of arteriovenous graft in maintenance hemodialysis patients:a retrospective cohort study

目的 评估维持性血液透析患者移植物动静脉内瘘(arteriovenous graft,AVG)的初级通畅率和次级通畅率,并分析影响维持性血液透析患者AVG生存的危险因素。方法 回顾性收集安徽省立医院2016年12月—2022年6月肾脏内科实施AVG手术的维持性血液透析患者的基础资料,并随访患者转归及AVG生存情况。采用Kaplan-Meier方法计算AVG技术存活率,采用COX回归模型分析AVG初级通畅率和次级通畅率的危险因素,并计算各个危险因素的风险比率(Hazard ratio,HR)及95%CI。结果 共51例维持性血液透析患者纳入本研究,手术成功出院后即失访8例,最终纳入43例行AVG手术的维持性血液透析患者。43例AVG初级通畅和次级通畅时间分别为6(1,12)月和8(2,30)月,手术后6、12及18个月的初级通畅率分别为53.9%、29.0%及19.9%,次级通畅率分别为80.8%、71.1%及67.1%。COX单因素回归分析显示中心静脉置管史(HR=2.091,95%CI:1.013~4.319,P=0.046)可能是影响AVG初级通畅率的危险因素。仅女性可能是AVG次级通畅的危险因素(HR=3.085,95%CI:1.022~9.305,P=0.046)。结论 AVG初级通畅时间及次级通畅时间均较短,长期通畅率低,提高AVG的长期通畅率任重道远,拟行AVG手术患者应尽量避免中心静脉置管,同时女性维持性血液透析患者选择AVG作为血液透析通路应更加慎重。手术后应进行密切规律的随访,及时干预可能会改善患者AVG次级通畅率。

Objective To assess the primary patency rate and secondary patency rate of arteriovenous graft(AVG),and to analyze the risk factors for survival of AVG in maintenance hemodialysis(MHD)patients.Methods Baseline data of the MHD patients undergoing AVG surgery at the Department of Nephrology,Anhui Provincial Hospital from December 2016 to June 2022 were retrospectively recruited.Patients were followed up for survival of AVG and prognosis of the patients.Kaplan-Meier method was used to calculate technical survival rate of AVG.Cox regression model was used to analyze the risk factors for primary patency and secondary patency of AVG.The risk ratio(HR)and 95%confidence interval(CI)were calculated for every risk factor.Results A total of 51 MHD patients undergoing AVG surgery were collected,and 43 of the 51 patients were finally enrolled in this study because of loss of follow-up in 8 patients.The primary patency and secondary patency periods were 6(1,12)and 8(2,30)months respectively in the 43 patients.After the surgery for 6,12 and 18 months,the primary patency rates were 53.9%,29.0%and 19.9%respectively,and the secondary patency rates were 80.8%,71.1%and 67.1%respectively.Univariate Cox regression showed that history of central venous catheterization(HR 2.091,95%CI:1.013~4.319,P=0.046)was the risk factor for primary patency rate of AVG,and female was the risk factor for secondary patency rate of AVG(HR 3.085,95%CI:1.022~9.305,P=0.046).Conclusion The primary patency and secondary patency periods of AVG were shorter and the long-term patency rate of AVG was lower,indicating the difficulties for a higher long-term patency rate of AVG.Central vein catheterization should be avoided in patients before AVG surgery.AVG should be carefully used for blood access in female MHD patients,Close follow-up after the surgery is required to treat complications in time to improve the secondary patency rate.