血液透析间期不同程度体质量增长对患者自体动静脉内瘘失功的影响  

Impact of different degrees of interdialytic weight gain on the dysfunction of autogenous arteriovenous fistula in maintenance hemodialysis patients

作　　者：陈迎归 宋利 孙春艳 周丽芳 郑淑倩 全梓林 赵立艳 崔冬梅 钟咪 赵宜娜 符霞 CHEN Ying-gui;SONG Li;SUN Chun-yan;ZHOU Lifang;ZHENG Shu-qian;QUAN Zi-lin;ZHAO Li-yan;CUI Dong-mei;ZHONG Mi;ZHAO Yi-na;FU Xia(School of Nursing,Southern Medical University,Guangzhou 510515,China;Division of Nephrology,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Shan Tou University Medical College,Shan Tou 515063,China)

机构地区：[1]南方医科大学护理学院,广州510515 [2]广东省人民医院(广东省医学科学院)肾内科,广州510080 [3]汕头大学医学院,汕头515063

出　　处：《中国血液净化》2021年第6期405-409,共5页Chinese Journal of Blood Purification

基　　金：广东省医学科学技术研究基金项目(A2020635)。

摘　　要：目的探讨血液透析间期不同程度体质量增长对患者自体动静脉内瘘(arteriovenous fistula,AVF)失功的影响。方法采用回顾性队列研究设计,选取2009年1月~2019年1月在广东省人民医院接受维持性血液透析(maintenance hemodialysis,MHD)治疗的患者577例,于2019年1月建立队列。收集患者入组前的临床资料,以患者2009年每次透析前体质量和干体质量计算每次透析间期体质量增长(interdialytic weight gain,IDWG)并取平均值,观察指标为AVF失功。结果研究对象分为IDWG≤4%组和IDWG>4%组,用倾向性评分匹配法控制2组混杂变量,共414例患者完成1:1匹配。匹配前后IDWG>4%组AVF失功率均高于IDWG≤4%组[34.2%比65.8%,χ^(2)=5.718,P=0.017;14.5%比22.7%,χ^(2)=4.611,P=0.032];二元Logistic回归分析结果显示,年龄(OR=3.393,95%CI:1.861~6.184,P<0.001)、IDWG(OR=1.967,95%CI:1.157~3.347,P=0.013)、血清白蛋白(OR=1.759,95%CI:1.034~2.990,P=0.037)、左心室质量指数(OR=1.008,95%CI:1.002~1.013,P=0.010)是AVF失功的独立危险因素。结论IDWG超过4%是MHD患者AVF失功的重要危险因素,特别是对于年龄大于60岁、血清白蛋白低于35g/L、左心室质量指数高的患者。Objective To explore the effect of interdialytic weight gain(IDWG)on the dysfunction of arteriovenous fistula(AVF)in maintenance hemodialysis(MHD)patients.Methods A total of 577 MHD patients treated in Guangdong Provincial People’s Hospital during the period from 2009 to 2019 were recruited for a retrospective and cohort study.Clinical data of the patients before entering the study were collected.The average IDWG was calculated based on the predialysis body weight and dry weight in every dialysis session in 2009.The observation index was AVF dysfunction.Results The MHD patients were divided into IDWG≤4%group and IDWG>4%group.The two groups of confounding variables were controlled by propensity score matching method and a total of 414 patients completed 1:1 matching.Before and after the matching,the AVF dysfunction in IDWG>4%group was higher than that in IDWG≤4%group(before matching:34.2%vs.65.8%,χ^(2)=5.718,P=0.017;after matching:14.5%vs.22.7%,χ^(2)=4.611,P=0.032).Binary logistic regression analysis showed that age(OR=3.393,95%CI 1.861~6.184,P<0.001),IDWG(OR=1.967,95%CI 1.157~3.347,P=0.013),serum albumin(OR=1.759,95%CI 1.034~2.990,P=0.037)and left ventricular mass index(OR=1.008,95%CI 1.002~1.013,P=0.010)were the independent risk factors for AVF dysfunction.Conclusion IDWG over 4%was an important risk factor for AVF dysfunction in MHD patients,especially in patients>60 years old,and with serum albumin<35 g/L and higher left ventricular mass index.

关 键 词：血液透析 透析间期体质量增长 动静脉内瘘失功 倾向性评分匹配法 

分 类 号：R318.16[医药卫生—生物医学工程]