提前建立动静脉内瘘早期失功的影响因素分析

Factors Influencing Early Failure of Arteriovenous Fistula in Advance Establishment

目的探讨终末期肾脏病(ESRD)患者提前建立自体动静内瘘(AVF)早期失功的影响因素。方法选取包头医学院第一附属医院肾内科提前建立AVF的患者130例,分为提前建立AVF术后早期失功组(16例)和非早期失功组(114例),收集相关资料,比较两组数据,采用COX回归分析AVF早期失功的独立危险因素,然后将独立危险因素分组后应用Log rank检验和Kaplan-Meier生存曲线对AVF术后失功率进行对比分析。结果单因素COX回归分析结果显示:两组患者原发病、有无吸烟史、有无糖尿病、血钙、血磷、甲状旁腺素、低密度脂蛋白和血浆白蛋白水平比较,差异均具有统计学意义。多因素COX回归分析发现患糖尿病、低白蛋白血症是提前建立AVF早期失功的独立危险因素。Log rank检验和Kaplan-Meier生存曲线分析发现血浆白蛋白水平及有无糖尿病,差异有统计学意义。结论糖尿病、低白蛋白血症是AVF早期失功的独立危险因素,所以临床工作中管理好患者血糖、血浆白蛋白能够降低提前期建立AVF早期失功的风险,提高ESRD患者首次AVF的使用率。

Objective To investigate the influential factors of early failure of autologous dynamic internal fistula(AVF)in patients with end-stage renal disease(ESRD).Methods A total of 130 patients with AVF established in advance in the Department of Nephropathy,The First Affiliated Hospital of Baotou Medical College were selected and divided into early postoperative AVF loss group(16 cases)and non-early postoperative AVF loss group(114 cases).Relevant data were collected and compared between the two groups.The independent risk factors for early Postoperative AVF loss were analyzed by COX regression.Log rank test and Kaplan-Meier survival curve were used to analyze the power loss after AVF after grouping independent risk factors.Results Univariate COX regression analysis showed that there were statistically Significant differences in the levels of primary disease,smoking,diabetes,blood calcium,blood phosphorus,parathyroid hormone,low density lipoprotein and plasma albumin between the two groups.Multivariate COX regression analysis showed that diabetes mellitus and hypoalbuminemia were independent risk factors for early AVF failure.Log rank test and Kaplan-Meier survival curve analysis showed that the difference between plasma albumin group and diabetes mellitus was statistically significant.Conclusions Diabetes mellitus and hypoalbuminemia are independent risk factors for early AVF loss.Therefore,good management of blood glucose and plasma albumin in clinical work can reduce the risk of early AVF loss and improve the utilization rate of ESRD patients entering hemodialysis for the first time.