血管通路类型对新血液透析患者炎症的影响  

Initial vascular access type contributes to inflammation in incident hemodialysis patients

作　　者：沙亚宾[1] 任万军[2] 康娜[1] 许琳[1] 

机构地区：[1]济南市第一人民医院血液净化中心,山东250011 [2]山东大学附属济南市中心医院肾脏病血液净化中心

出　　处：《中国地方病防治》2013年第4期308-311,共4页Chinese Journal of Control of Endemic Diseases

摘　　要：目的研究不同的血管通路类型对新血液透析(HD)患者炎症状态的影响,为HD患者选择最优血管通路。方法对150例新HD患者进行前瞻性观察研究。按血管通路类型分为4组,半永久性置管(TC)组40例,自体动静脉内瘘(AVF)组50例,临时置管+自体动静脉内瘘(C+AVF)组50例,动静脉移植血管(AVG)组10例。分别在建立血管通路前及建立血管通路1年内测定血清C反应蛋白(CRP)水平共7次。以CRP为因变量,校正年龄、性别、冠脉疾病、糖尿病、感染、通路血栓、HD和手术后天数,进行混合效果模式分析。并记录各组3月内死亡率。结果与AVF相比,采用TC和AVG者血清CRP水平明显升高,而C+AVF者无显著变化。混合效果模式分析标明血管通路类型(TC、AVG)是重要的预测因素。结论患者开始HD应用TC或AVG体内炎症状态增高,可能促进HD开始后90 d死亡率升高。HD患者选用AVF或C+AVF血管通路可减少体内炎症发生。Objective This study was designed to understand the contribution of different hemodialysis （HD） type to inflammation in incident hemodialysis patients and to select optimal vascular access for hemodialysis patients. Methods We conducted a prospective observational study in an incident HD population. 150 incident HD patients were included （ tunneled catheter （TC）, n =40, arteriovenous fistula （AVF）, n = 50, catheter ＋ arteriovenous fistula, n = 50, and arteriovenous graft （AVG）, n = 10）. C - reactive protein （CRP） was measured before and at 6 - time points after access placement for 1 year. A mixed effects model was performed for CRP adjusting for age, sex, coronary artery disease, diabetes mellitus, infections, access thrombosis, initiation of HD, and days after access surgery. The mortality within 3 months after HD was recorded. Results In comparison to AVFs, the presence of a TC and AVG were associated with significantly higher levels of CRP. TC and AVG were important predictors of a higher CRP level. Conclusions Patients who initiate HD with a TC or an AVG have a heightened state of inflammation, which may contribute to the excess 90 - day mortality after HD initiation. Patients who initiate HD with a AVF or a C ＋ AVF may have a lower state of inflammation compared to those with a TC or an AVG.

关 键 词：血管通路 C反应蛋白 血液透析 

分 类 号：R459.5[医药卫生—治疗学]