自体动静脉内瘘术前桡动脉病理变化与血液透析患者全因死亡的相关性  

Pathological changes of arteriovenous fistula and its relationship with all-cause mortality in hemodialysis patiengts

作　　者：周震[1] 曾斌[1] 王佳玲[2] 郑则钦[3] Zhou Zhen;Zeng Bin;Wang Jialing;Zheng Zeqin(Department of Nephrology,the Second People's Hospital of Shantou,Shantou 515000,China;Department of Color Ultrasonic Room,the Second People's Hospital of Shantou city,Shantou 515000,China;Department of Pathology,the Second People's Hospital of Shantou city,Shantou 515000,China)

机构地区：[1]广东省汕头市第二人民医院肾内科,汕头515000 [2]广东省汕头市第二人民医院彩超室,汕头515000 [3]广东省汕头市第二人民医院病理科,汕头515000

出　　处：《国际泌尿系统杂志》2022年第1期90-94,共5页International Journal of Urology and Nephrology

摘　　要：目的探讨慢性肾脏病5期患者行自体动静脉内瘘术前桡动脉血管的病理变化与血液透析患者全因死亡的相关性。方法选取2009年1月1日至2018年12月31日在本院确诊为慢性肾脏病5期行自体动静脉内瘘成形术的患者140例,收集人口学资料、临床资料及实验室检查结果。所有患者随访至2019年6月。根据行自体动静脉内瘘术前取的桡动脉血的病理学检查结果将患者分成血管内膜轻中度增厚组(66例)和血管内膜重度增厚组(74例),分别采用单因素和多因素分析影响血管内膜厚度的因素,采用Cox生存函数分析两组患者的全因死亡率。结果血管内膜重度增厚组的三酰甘油、钙、磷、甲状旁腺素水平较血管内膜轻中度增厚组高(P<0.05);血管内膜重度增厚组的左室收缩末直径、左室舒张末直径均较血管内膜轻中度增厚组明显增高(P<0.05),左室射血分数较血管内膜轻中度增厚组明显降低(P<0.05);多因素logistic回归分析显示,钙、磷、三酰甘油、甲状旁腺素和左室射血分数是血管内膜厚度的影响因素(P<0.05),其中左室射血分数是保护因素(P<0.05);术后血管内膜重度增厚组的生存时间较血管内膜轻中度增厚组明显降低(χ^(2)=4.355,P=0.037);两组患者死亡的主要因素为心脑血管疾病。结论与血管内膜轻中度增厚患者相比,自体动静脉内瘘术前血管内膜重度增厚患者的钙、磷及脂代谢紊乱较明显,全因死亡率明显增高。Objective To investigate the pathological changes of radial artery and cephalic vein in patients with chronic kidney disease at stage 5(CKD5)during the internal arteriovenous fistula surgery,and its relationship with all-cause mortality in hemodialysis patiengts.Methods A total of 140 patients with autogenous arteriovenous fistula who were diagnosed as stage 5 chronic kidney disease in our hospital from January 1,2009 to December 31,2018 were selected.Demographics,baseline clinical and laboratory test results were collected.All patients were followed up until June 2019.According to the pathological examination results of radial artery blood taken before autologous arteriovenous fistula,the patients were divided into mild and moderate vascular intima thickening group(66 cases)and severe vascular intima thickening group(74 cases).Univariate and multivariate were used to analyze the factors influencing the thickness of vascular intima,and Cox survival function was used to analyze the survival rate of two groups.Results Compared with the mild to moderate thickening endangium group,the cases of primary onset of diabetes were higher(P<0.05),the triglycerides,calcium,phosphorus,parathyroid hormone,the left ventricular end systolic diameter and left ventricular end diastolic diameter were higher(P<0.05),and the left ventricular ejection fraction is significantly reduced in the severe thickening endangium group(P<0.05).Logistic regression analysis showed that calcium,phosphorus,triglycerides,parathyroid hormone,and left ventricular ejection fraction were factors affecting the thickness of the vascular intima(P<0.05),and left ventricular ejection fraction was the protective factor(P<0.05).Compared with the mild to moderate endometrial thickening group,the survival time of the severe endometrial thickening group was significantly reduced(χ^(2)=4.355,P=0.037).The factor was cardiovascular and cerebrovascular diseases.Conclusions Compared with the mild to moderate thickening of the vascular intima,patients with severe thicke

关 键 词：肾透析 动静脉瘘 桡动脉 病理状态 体征和症状 

分 类 号：R692[医药卫生—泌尿科学]