血管通路引起的肢体远端缺血征的危险因素分析

Risk factors for distal limb ischemia syndrome caused by vascular access

目的分析血管通路引起的肢体远端缺血征(hemodialysis access-induced distal ischemia,HAIDI)的危险因素。方法选取2020年5月—2022年5月在荣县人民医院肾病内科首次行动静脉内瘘手术进行血液透析的终末期肾病患者。根据患者手术后是否出现HAIDI相关症状分为HAIDI组与非HAIDI组;收集并比较2组临床资料,通过组间单因素分析筛选出导致HAIDI发生的可能危险因素,并对可能的危险因素进行量化,行二元Logistic回归分析。结果共纳入70例患者,其中HAIDI组15例,非HAIDI组55例。单因素分析结果显示:HAIDI组年龄≥60岁、女性、高血压史、糖尿病史、系统性红斑狼疮、血管炎、透析龄>1年、血管通路类型(移植物动静脉内瘘、肱动脉自体动静脉内瘘比例)均高于非HAIDI组(χ^(2)/t分别为4.419、4.272、4.904、6.360、10.972、7.231、5.657、18.670,P分别为0.036、0.039、0.027、0.012、0.001、0.007、0.017、<0.001);二元Logistic回归分析结果显示:高龄、女性、高血压史、糖尿病史、系统性红斑狼疮、血管炎、透析龄长、移植物动静脉内瘘及高位动静脉内瘘是导致HAIDI发生的主要危险因素(OR分别为0.286、3.353、0.274、0.224、0.051、0.074、4.111、0.055、0.049;95%CI分别为0.086~0.954、1.030~10.920、0.084~0.895、0.066~0.755、0.005~0.500、0.007~0.775、1.223~13.818、0.010~0.303、0.007~0.321,P分别为0.042、0.045、0.032、0.016、0.011、0.030、0.022、0.001、0.002)。结论年龄、性别、高血压、糖尿病、系统性红斑狼疮、血管炎、透析龄及血管通路类型是HAIDI的危险因素,对于HAIDI高危人群进行针对性的预防控制措施,有助于减少血管通路引起的HAIDI发生。

Objective To analyze the risk factors for hemodialysis access-induced distal ischemia(HAIDI)syndrome.Methods This study enrolled 70 end-stage renal disease patients undergoing hemodialysis for the first time in Department of Nephrology,Rongxian People's Hospital from May 2025 to May 2022.According to the presence or absence of HAIDI syndrome,they are divided into HAIDI group(n=15)and the non-HAIDI group(n=55).Clinical data were collected and compared between the two groups.Univariate analysis was conducted to find out the potential risk factors for HAIDI syndrome.Binary logistic regression was used to quantify the potential risk factors.Results Univariate analysis showed that the ratios of≥60 years of age,female,hypertension history,diabetes,vasculitis,systemic lupus erythematosus,dialysis age more than one year,arteriovenous fistula(AVF)graft,and autologous AVF using brachial artery were higher in HAIDI group than in non-HAIDI group(χ^(2)/t=4.419,4.272,4.904,6.360,10.972,7.231,5.657 and 18.670 respectively;P=0.036,0.039,0.027,0.012,0.001,0.007,0.017 and<0.001 respectively).Binary logistic regression analysis showed that older age,female,hypertension history,diabetes history,vasculitis,systemic lupus erythematosus,longer dialysis age,AVF graft,and AVF of higher position were the risk factors for HAIDI(OR=0.286,3.353,0.274,0.224,0.051,0.074,4.111,0.055 and 0.049 respectively;95%CI:0.086~0.954,1.030~10.920,0.084~0.895,0.066~0.755,0.005~0.500,0.007~0.775,1.223~13.818,0.010~0.303 and 0.007~0.321 respectively;P=0.042,0.045,0.032,0.016,0.011,0.030,0.022,0.001 and 0.002 respectively).Conclusion Age,sex,hypertension,diabetes,vasculitis,systemic lupus erythematosus,dialysis age and vascular access type are the risk factors for HAIDI.Prevention and control measures focusing on the patients with these risk factors will help reduce the occurrence of HAIDI syndrome.