阿托伐他汀对合并有糖尿病的终末期肾病病人动静脉内瘘功能的影响研究  

A study of the effect of atorvastatin on arteriovenous fistula function in patients with end-stage renal disease complicated with diabetes mellitus

作　　者：王旭[1] 汪楠 吴国仲[1] 刘伟[1] 施杰[1] 黄小抗 蔡军军 韩久怀[1] WANG Xu;WANG Nan;WU Guozhong;LIU Wei;SHI Jie;HUANG Xiaokang;CAI Junjun;HAN Jiuhuai(Department of Nephrology,Anqing Municipal Hospital,Anqing,Anhui 246000,China;Department of Pharmacy Management,Anqing Municipal Hospital,Anqing,Anhui 246000,China)

机构地区：[1]安庆市立医院肾内科,安徽安庆246000 [2]安庆市立医院药事管理科,安徽安庆246000

出　　处：《安徽医药》2023年第9期1877-1881,I0004,共6页Anhui Medical and Pharmaceutical Journal

基　　金：安徽医科大学科学研究基金(2018xkj077)。

摘　　要：目的研究阿托伐他汀对合并有糖尿病的终末期肾病病人动静脉内瘘(AVF)的功能影响。方法回顾性收集2018年1月至2019年12月在安庆市立医院肾内科住院并成功行自体AVF手术的合并有糖尿病的终末期肾病病人的病例资料(n=135例),根据是否口服阿托伐他汀,分为他汀组(n=63例)和对照组(n=72例)。比较两组病人血脂变化、内瘘功能,探究内瘘失功原因,应用Kaplan-Meier分析比较两组内瘘失功情况,采用Cox回归模型分析阿托伐他汀的应用与内瘘失功的相关性,并比较两组病人的不良事件及预后。结果他汀组术后6个月总胆固醇、三酰甘油、低密度脂蛋白均低于对照组,差异有统计学意义(P<0.05);他汀组术后6个月时内瘘血流量高于对照组,差异有统计学意义(P<0.05);术后18个月时内瘘失功率[(33.3%,21/63)]低于对照组[(54.2%,39/72)],差异有统计学意义(P<0.05);两组失功原因相比较,他汀组内瘘狭窄的比例[(28.6%,6/21)]低于对照组[(56.4%,22/39)],差异有统计学意义(P<0.05);Kaplan-Meier生存曲线提示他汀组内瘘失功率低于对照组,差异有统计学意义(P<0.05);多因素Cox回归分析显示女性[HR=2.11,95%CI:(1.14,3.90),P=0.017]为影响AVF失功的独立危险因素,头静脉内径[HR=0.18,95%CI:(0.06,0.48),P=0.001]、应用阿托伐他汀[HR=0.50,95%CI:(0.29,0.86),P=0.011]为影响AVF失功的保护因素(P<0.05)。他汀组病人脑梗死发生率[3.2%(2/63)]低于对照组[13.9%(10/72)],差异有统计学意义(P<0.05)。结论应用阿托伐他汀能降低合并有糖尿病的终末期肾病病人AVF失功风险。Objective To investigate the effect of atorvastatin on the function of arteriovenous fistula in patients with end-stage renal disease complicated with diabetes mellitus.Methods Retrospectively collected case data of patients with end-stage renal disease combined with diabetes mellitus who were hospitalized in the Department of Nephrology of Anqing Municipal Hospital and successfully underwent autologous AVF surgery from January 2018 to December 2019(n=135 cases)were divided into the statin group(n=63 cases)and the control group(n=72 cases),according to whether they were taking atorvastatin.Comparing the two groups of patients with blood lipid changes,exploring the causes of internal fistula failure,applying Kaplan‒Meier analysis to compare the internal fistula failure of the two groups,analyzing the correlation between the application of atorvastatin and internal fistula failure by using the Cox regression model,and comparing the adverse events and prognosis of the two groups of patients.Results Total cholesterol,triglyceride and lowdensity lipoprotein levels in the statin group were lower than those in the control group at 6 months postoperatively,and the differences were statistically significant(P<0.05).The internal fistula blood flow in the statin group was higher than that in the control group at 6 months postoperatively,and the difference was statistically significant(P<0.05).Internal fistula power loss at 18 months postoperatively[33.3%(21/63)]was lower than that in the control group[54.2%(39/72)],with a statistically significant difference(P<0.05).Comparing the causes of loss of power between the two groups,the ratio of internal fistula stenosis in the statin group[28.6%(6/21)]was lower than that in the control group[56.4%(22/39)],with a statistically significant difference(P<0.05).The Kaplan‒Meier survival curve indicated that the power of internal fistula loss in the statin group was lower than that in the control group,and the difference was statistically significant(P<0.05).Multivariate Cox regres

关 键 词：糖尿病肾病 尿毒症 阿托伐他汀 肾透析 终末期肾病 动静脉内瘘 

分 类 号：R587.2[医药卫生—内分泌] R692.5[医药卫生—内科学]