糖尿病对终末期肾脏病患者动静脉内瘘早期失功的影响  

Association of Diabetes and Early Failure of Arteriovenous Fistula in the End Stage of Renal Diseases

作　　者：崔天蕾[1] 张任重[1] 刘芳[1] 唐万欣[1] 付平[1] 周莉[1] 陶冶[1] 胡章学[1] 

机构地区：[1]四川大学华西医院肾脏内科,成都610041

出　　处：《四川大学学报（医学版）》2012年第3期438-441,共4页Journal of Sichuan University(Medical Sciences)

摘　　要：目的研究糖尿病肾病患者血糖长期控制情况与自体动静脉内瘘早期失功的相关性。方法观察266例行自体动静脉内瘘术的终末期肾脏病(ESRD)患者,分为非糖尿病组、糖尿病肾病组(又分为糖化血红蛋白(HbA1C)<7%和HbA1C≥7%亚组),比较各组内瘘早期失功率,并分析内瘘早期失功的相关危险因素。结果 266例患者中非糖尿病患者165例,糖尿病肾病患者101例,其中HbA1C<7%者51例,HbA1C≥7%者50例。共有63例(23.7%)发生早期动静脉内瘘失功,非糖尿病组、糖尿病肾病组中HbA1C<7%和HbA1C≥7%组内瘘早期失功率分别为18.1%(30/165)、21.6%(11/51)、44.0%(22/50)。非糖尿病组和HbA1C<7%组早期失功率均低于HbA1C≥7%组,差异有统计学意义(P<0.05);非糖尿病组早期失功率与HbA1C<7%组相比差异无统计学意义。COX多因素回归分析发现随着HbA1C、总胆固醇的升高,内瘘早期失功的危险性增加,高密度脂蛋白是内瘘通畅的保护性因素。结论血糖长期控制水平及血脂异常为糖尿病ESRD患者自体动静脉内瘘早期失功的重要影响因素,控制血糖及调节血脂可以降低内瘘早期失功率。Objective To determine the association of diabetes and glycemic control with early failure of native arteriovenous fistula（AVF）.Methods 266 patients with end stage renal diseases（ESRD）were recruited and divided into non-diabetic group（165）,HbA1C7% group（51） and HbA1C≥7% group（50）.Clinical indicators and early failure of AVF were examined.Results In total,63（23.7%） patients had AVF early failure.The AVF early failure occurred in 18.1% of patients in the non-diabetic group and 21.6% of patients in the HbA1C7% group,significantly less than that in the HbA1C≥7% group（44%）.The COX regression model showed that increased HbA1C,total cholesterol（TC）and decreased high-density lipoprotein（HDL）increased the risk of AVF failure.Conclusion The levels of glycemic and serum lipid subfractions are associated with AVF early failure in ESRD patients.Good control of glycemic and lipid can lower the rates of AVF early failure.

关 键 词：糖尿病 动静脉内瘘 早期失功 

分 类 号：R459.5[医药卫生—治疗学]