腹膜透析患者自体动静脉内瘘成熟不良的影响因素分析

Study on the influencing factors of autogenous arteriovenous fistula failure in peritoneal dialysis patients

目的了解腹膜透析(peritoneal dialysis,PD)患者建立自体动静脉内瘘(arteriovenous fistula,AVF)的成熟情况,探讨内瘘成熟不良的影响因素。方法纳入2018年1月1日─2023年6月30日在浙江省台州医院肾内科首次行AVF手术的PD患者。根据内瘘是否自行发育成熟,分为无辅助成熟组和无辅助成熟不良组,对比2组患者基线资料之间的差异。多因素Logistic回归分析AVF成熟不良的影响因素。结果本研究共纳入116例PD患者,AVF非辅助成熟率为76%,辅助成熟率为93%。成熟不良组女性比例更高(χ^(2)=10.830,P=0.001),平均动脉压更低(t=3.106,P=0.002),原发病为糖尿病肾病比例更高(χ^(2)=4.087,P=0.043),手术前血红蛋白水平更高(t=-2.376,P=0.019)。多因素Logistic回归分析显示女性(OR=4.813,95%CI:1.736~13.339,P=0.003)、平均动脉压(OR=0.960,95%CI:0.927~0.995,P=0.024)是PD患者AVF成熟不良的独立影响因素。结论PD患者首次AVF的成熟率与一般人群相仿,女性患者AVF成熟率低于男性,手术前较低的平均动脉压与内瘘成熟不良相关。

Objective To investigate the maturation rate of autologous arteriovenous fistula(AVF)in peritoneal dialysis(PD)patients,and to explore the influencing factors for AVF failure in PD patients.Methods Patients on PD undergoing AVF surgery for the first time in the hospital between January 1,2018 and June 30,2023 were enrolled in this study.According to whether the AVF maturation with assistance,the patients were divided into the non-assisted AVF maturation group and the non-assisted AVF failure group.Baseline data were compared between the two groups.Multivariate logistic regression was used to analyze the influencing factors for AVF failure.Results A total of 116 PD patients were enrolled in this study.The non-assisted AVF maturation rate was 76%and the assisted AVF maturation rate was 93%.In the non-assisted AVF failure group,female proportion was higher(χ^(2)=10.830,P=0.001),mean arterial pressure was lower(t=3.106,P=0.002),ratio of diabetes as the primary disease was higher(χ^(2)=4.087,P=0.043),and preoperative hemoglobin level was higher(t=-2.376,P=0.019).Multivariate logistic regression showed that female(OR=4.813,95%CI:1.736~13.339,P=0.003)and mean arterial pressure(OR=0.960,95%CI:0.927~0.995,P=0.024)were the independent risk factors for AVF failure in PD patients.Conclusions The maturation rate of the first AVF in PD patients is similar to that in general population.Females and lower preoperative mean arterial pressure are associated with poor AVF maturation in PD patients.