血液透析患者血管钙化程度与动静脉内瘘失功的关系  

Impact of vascular calcification on arteriovenous fistula dysfunction in hemodialysis patients

作　　者：陈圳炜[1] 袁丽萍[1] 何东玲[1] 罗敏虹[1] 曾海鸥[1] 伍强[1] 杨铁城[1] 

机构地区：[1]广东省深圳市第四人民医院,深圳518000

出　　处：《中国血液净化》2015年第11期649-653,共5页Chinese Journal of Blood Purification

摘　　要：目的探讨血液透析（HD）患者血管钙化（VC）程度与动静脉内瘘（AVF）失功的关系。方法收集HD患者行自体AVF成形术废弃的桡动脉,行钙化染色后分组观察,记录一般情况和检测生化指标,多因素Logistic回归分析AVF失功的危险因素。结果 110例HD患者中17例（15.45%）存在不同程度的VC。重度钙化组血肌酐（1172.33±490.75）μmol/L、中位透析时间[72.92（8.40~182.17）]月较非钙化组及轻中度钙化组明显增高（P〈0.05）;AVF失功与血红蛋白（r=0.480,P=0.000）、血磷（r=0.256,P=0.007）、钙磷乘积（r=0.293,P=0.002）、血肌酐（r=0.309,P=0.001）、透析时间（r=0.266,P=0.005）呈正相关;多因素Logistic回归分析结果显示,血红蛋白是AVF失功的发生的危险因素。结论不同程度VC对1年内AVF失功并无影响,长期透析是导致重度VC的危险因素,AVF失功与血红蛋白、血磷、钙磷乘积、血肌酐、透析时间呈正相关,血红蛋白是HD患者发生AVF失功的重要危险因素。Objective To investigate the impact of vascular calcification （VC） on arteriovenous fistula （AVF） dysfunction in hemodialysis （HD） patients. Methods Segments of radial artery were obtained during the arteriovenous fistula operation for HD patients. VC was examined by von Kossa staining. Clinical and bio- chemical data were collected. Parameters relating to VC were then analyzed by binary logistic regression anal- ysis. Results Among the 110 HD cases, 17 cases （15.45%） had VC in radial arteries of different degrees. Se- rum creatinine （1172.33±490.75 μmol/L） and dialysis duration [72.92 （8.40-182.170） months] were signifi- cantly higher in patients with severe VC than in those without VC or with mild to moderate VC （P（0.05）. AVF dysfunction was positively correlated with hemoglobin （1=0.408, P=-0.000）, phosphorus （1=0.256, P=- 0.007）, calcium-phosphorus product （1=0.293, P=0.002）, serum creatininc （1=0.309, P=-0.001）, and dialysis du- ration （r=0.266, P=0.005）. Binary logistic regression analysis showed that hemoglobin correlated with AVF dysfunction. Conclusions Different degree of VC had no effect on AVF dysfunction in one year. Dialysis du- ration was the main influential factor for VC in HD patients. Higher hemoglobin correlated closely with AVF dysfunction.

关 键 词：血液透析 血管钙化 动静脉内瘘 

分 类 号：R318.16[医药卫生—生物医学工程]