摘要
目的分析维持性血液透析患者自体动静脉内瘘功能不良及经皮腔内血管成形术(PTA)术后狭窄的影响因素。方法收集本院收治的120例行自体动静脉内瘘的维持性血液透析患者的临床资料,根据是否发生自体动静脉内瘘功能不良分为良好组(n=72)和不良组(n=48)。不良组患者根据PTA术后是否发生狭窄分为狭窄组(n=16)和未狭窄组(n=32)。采用单因素和多因素Logistic回归分析维持性血液透析患者自体动静脉内瘘功能不良及PTA术后狭窄的影响因素。结果自体动静脉内瘘功能良好组和不良组患者年龄、体质指数、低血压、糖尿病、瘘口直径、吸烟史、C反应蛋白(CRP)水平、血栓形成占比比较,差异有显著性(P<0.05)。狭窄组和未狭窄组糖尿病、低血压、钙磷乘积、钙磷代谢紊乱、血清凝血酶-抗凝血酶复合物测定(TAT)水平、淋巴细胞计数比较,差异有显著性(P<0.05)。年龄≥65岁、体质指数≥21 kg/m^(2)、合并低血压、合并糖尿病、瘘口直径<3.6 mm、吸烟史、CRP≥25 mg/L、血栓形成是维持性血液透析患者自体动静脉内瘘功能不良的独立影响因素(P<0.05)。合并糖尿病、低血压、钙磷乘积≥0.004 g^(2)/L^(2)、合并钙磷代谢紊乱、血清TAT≥3.648μg/L、淋巴细胞计数≥4×109/L是维持性血液透析自体动静脉内瘘功能不良患者PTA术后狭窄的独立影响因素(P<0.05)。结论年龄≥65岁、体质指数≥21 kg/m^(2)、合并低血压、合并糖尿病、瘘口直径<3.6 mm、吸烟史、CRP≥25 mg/L、血栓形成是维持性血液透析患者自体动静脉内瘘功能不良的独立影响因素。合并糖尿病、合并低血压、钙磷乘积≥0.004 g^(2)/L^(2)、合并钙磷代谢紊乱、血清TAT≥3.648μg/L、淋巴细胞计数≥4×10^(9)/L是维持性血液透析自体动静脉内瘘功能不良患者PTA术后狭窄的独立影响因素。
Aim To analyze the influencing factors of autogenous arteriovenous fistula dysfunction and post-percutaneous transluminal angioplasty(PTA)stenosis in maintenance hemodialysis patients.Methods A total of 120 maintenance hemodialysis patients with autologous arteriovenous fistula were divided into a good function group(n=72)and a dysfunction group(n=48)according to autologous arteriovenous fistula function.The dysfunction group was further divided into stenosis group(n=16)and non-stenosis group(n=32)based on post-PTA status.Univariate and multivariate Logistic regression were used to analyze the influencing factors of autogenous arteriovenous fistula dysfunction and post-PTA stenosis in maintenance hemodialysis patients.Results There were significant differences in age,body mass index,hypotension,diabetes,fistula diameter,smoking history,C-reactive protein(CRP)level,and the proportion of thrombosis between the good function group and the dysfunction group(P<0.05).There were significant differences in diabetes,hypotension,calcium phosphorus product,calcium phosphorus metabolic disorder,serum thrombin-antithrombin test(TAT)level and lymphocyte count between the stenosis group and the non-stenosis group(P<0.05).Age≥65 years,body mass index≥21 kg/m^(2),combined hypotension,diabetes,fistula diameter<3.6 mm,smoking history,CRP≥25 mg/L,thrombosis were independent influencing factors for poor function of autogenous arteriovenous fistula in maintenance hemodialysis patients(P<0.05).Diabetes,hypotension,calcium phosphorus product≥0.004 g^(2)/L^(2),calcium phosphorus metabolic disorder,serum TAT≥3.648μg/L,lymphocyte count≥4×10^(9)/L were independent influencing factors for recurrent restenosis after PTA in patients with poor function of autogenous arteriovenous fistula in maintenance hemodialysis(P<0.05).Conclusion Age≥65 years,body mass index≥21 kg/m^(2),combined hypotension,diabetes,fistula diameter<3.6 mm,smoking history,CRP≥25 mg/L,thrombosis were independent influencing factors for poor function of autogenous arteriovenous fistula in maintenance hemodialysis patients.Diabetes,hypotension,calcium phosphorus product≥0.004 g^(2)/L^(2),calcium phosphorus metabolic disorder,serum TAT≥3.648μg/L,lymphocyte count≥4×10^(9)/L were independent influencing factors for recurrent restenosis after PTA in patients with poor function of autogenous arteriovenous fistula in maintenance hemodialysis.
作者
何静
梅吉本
胡艳
束长东
陈忠辉
HE Jing;MEI Jiben;HU Yan;SHU Changdong;CHEN Zhonghui(Department of Nephrology,Xuancheng People's Hospital,Xuancheng 242000,Anhui,China)
出处
《中南医学科学杂志》
2025年第4期720-723,727,共5页
Medical Science Journal of Central South China
基金
宣城市人民医院院级科研项目(KY202110)。
