不同血管通路类型对维持性血液透析患者生存影响的研究  

Effects of different types of vascular access on survival of maintenance hemodialysis patients

作　　者：安娜[1] 李洪[1] 陈汝满 王春莉 白亚飞[1] 徐明芝[1] 王翠娟 AN Na;LI Hong;CHEN Ru-man;WANG Chun-li;BAI Ya-fei;XU Ming-zhi;WANG Cui-juan(Blood Purification Center,Hainan Provincial People’s Hospital(Hainan Hospital Affiliated to Hainan Medical University),Haikou 570311,China)

机构地区：[1]海南省人民医院-海南医学院附属海南医院血液净化中心,海口570311

出　　处：《中国血液净化》2022年第9期681-685,共5页Chinese Journal of Blood Purification

基　　金：海南省医药卫生科研项目(20A200225);海南省临床医学中心建设项目。

摘　　要：目的探讨不同血管通路类型对维持性血液透析(maintenance hemodialysis,MHD)患者3年生存的影响。方法前瞻性队列研究设计,纳入2017年1月1日~2017年12月31日在海南省人民医院血液透析的MHD患者216例,随访3年。根据血管通路类型分2组:自体动静脉内瘘(autostatic arteriovenous fistula,AVF)组和带隧道涤纶套导管(tunneled cuffed catheter,TCC)组。观察终点为患者3年全因死亡。结果(1)216例患者中年龄≥60岁者86例(39.8%),糖尿病肾病60例(27.8%),男性132例(61.1%),TCC组55例(25.5%)。(2)2组死亡原因构成比无统计学差异(χ^(2)=0.676,P=0.879);AVF组第一位死亡原因是心血管事件(39.5%),其次是感染(30.2%),TCC组分别是感染(39.3%)和心血管事件(35.7%)。(3)随访期间AVF组累积生存率高于TCC组(χ^(2)=9.618,P=0.002)。(4)单因素分析显示:年龄(OR=2.854,95%CI:1.766~4.612,P<0.001)、透析龄(OR=0.973,95%CI:0.963~0.983,P<0.001)、原发病(OR=2.296,95%CI:1.435~3.673,P=0.001)、血管通路类型(OR=2.091,95%CI:1.294~3.378,P=0.003)、白蛋白(OR=4.281,95%CI:2.050~8.938,P<0.001)和胸部CT影像(OR=0.409,95%CI:0.255~0.655,P<0.001)是影响患者全因死亡的重要因素。(5)多因素COX回归分析:校正原发病、年龄、透析龄、白蛋白、血管通路及胸部CT影像后,维持性血管通路类型(OR=0.921,95%CI:0.545~1.557,P=0.759)对全因死亡无直接影响;透析龄(OR=0.976,95%CI:0.966~0.986,P<0.001)、低白蛋白(OR=2.898,95%CI:1.327~6.330,P=0.008)和胸部CT影像改变(OR=2.060,95%CI:1.258~3.376,P=0.004)是全因死亡的独立危险因素。结论AVF与TCC作为MHD血管通路对患者生存无直接影响;积极纠正营养不良,提高白蛋白水平及有效防治肺部炎症,改善CT影像异常可提高患者生存率。Objective To investigate the effects of different vascular access types on survival of maintenance hemodialysis(MHD)patients.Methods A prospective cohort study was performed,which included 216 MHD patients treated in Hainan Provincial People's Hospital from January 1,2017 to December 31,2017.The patients were followed up for 3 years.According to vascular access type,they were divided into 2 groups:autologous arteriovenous fistula(AVF)group and tunneled cuffed catheter(TCC)group.The observation endpoint was all-cause death in the follow-up period of 3 years.Results①In the 216 MHD patients,86 patients were in the age of≥60 years,60 patients(27.8%)had diabetic nephropathy,132(61.1%)were males,55 patients(25.5%)were in the TCC group.②The cause of death was similar between the two groups(χ^(2)=0.676,P=0.879).In AVF group,the first cause of death was cardiovascular events(39.5%),followed by infection(30.2%);in TCC group,the first cause of death was infection(39.3%),followed by cardiovascular events(35.7%).③The cumulative survival rate in the 3-year follow-up period was higher in AVF group than in TCC group(χ^(2)=9.618,P=0.002).④Univariate regression showed that age(OR=2.854,95%CI 1.766~4.612,P<0.001),dialysis vintage(OR=0.973,95%CI 0.963~0.983,P<0.001),primary disease(OR=2.296,95%CI 1.435~3.673,P=0.001),vascular access(OR=2.091,95%CI 1.294~3.378,P=0.003),albumin(OR=4.281,95%CI 2.050~8.938,P<0.001)and chest CT findings(OR=0.409,95%CI 0.255~0.655,P<0.001)were the important factors affecting all-cause death.⑤Multivariate Cox regression after correction for primary disease,age,dialysis vintage,hemoglobin,albumin,chest CT findings showed that vascular access was not the independent risk factor for all-cause death in MHD patients(OR=0.921,95%CI 0.545~1.557,P=0.759);while dialysis vintage(OR=0.976,95%CI 0.966~0.986,P<0.001),albumin(OR=2.898,95%CI 1.327~6.330,P=0.008)and chest CT findings(OR=2.060,95%CI 1.258~3.376,P=0.004)were the independent risk factors for all-cause death in MHD patients.Conclusions AVF and T

关 键 词：维持性血液透析 自体动静脉内瘘 导管 生存率 

分 类 号：R318.16[医药卫生—生物医学工程]