慢性肾脏病患者中心静脉狭窄的危险因素及中心静脉狭窄对动静脉内瘘功能的影响  

Risk factors of central vein stenosis in patients with chronic kidney disease and the effects on the function of arteriovenous fistula

作　　者：廉庆楼 刘亚敏 李昱保 王宇飞[1] 张倍豪[1] 王欣芳[1] 赵培翔 王瑞敏[1] 梁献慧[1] 王沛[1] Lian Qinglou;Liu Yamin;Li Yubao;Wang Yufei;Zhang Beihao;Wang Xinfang;Zhao Peixiang;Wang Ruimin;Liang Xianhui;Wang Pei(Blood Purification Center,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院血液净化中心,郑州450052

出　　处：《中华肾脏病杂志》2023年第10期752-759,共8页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81873612,82100755)。

摘　　要：目的分析首次建立动静脉内瘘的慢性肾脏病(chronic kidney disease,CKD)患者中心静脉狭窄(central vein stenosis,CVS)的发生率、危险因素及其对同侧动静脉内瘘初级通畅的影响。方法该研究为回顾性研究。纳入2019年1月至2020年8月在郑州大学第一附属医院首次建立上肢动静脉内瘘且术前有中心静脉数字减影血管造影检查结果的CKD患者为研究对象。比较有、无颈部透析用中心静脉导管置管史患者CVS发生率及CVS组与无CVS组动静脉内瘘初级通畅率的差异。采用Logistic回归法分析CKD患者发生CVS的影响因素;Kaplan-Meier法分析动静脉内瘘的初级通畅率;Cox回归法分析CVS对同侧动静脉内瘘初级通畅的影响。结果283例CKD患者入选该研究,年龄(50.45±14.76)岁,男165例(58.3%),中位透析龄0.5(0,7.0)个月,55例(19.4%)患者动静脉内瘘成形术前存在CVS,其中狭窄程度<50%39例,狭窄程度≥50%16例。有右颈部中心静脉导管置管史患者CVS发生率显著高于无置管史患者[60.5%(26/43)比9.9%(15/151),χ^(2)=51.274,P<0.001]。多因素Logistic回归分析结果显示,颈部透析用中心静脉导管留置时间≥3个月(OR=4.345,95%CI 1.540~12.263,P=0.006)是CKD患者发生CVS的独立影响因素。在268例CVS同侧肢体建立动静脉内瘘的患者中,中位随访34个月,中重度CVS组患者的动静脉内瘘初级通畅率显著低于无CVS组(5/7比58/228,χ^(2)=7.720,P=0.005),锁骨下静脉狭窄及上腔静脉狭窄组患者的动静脉内瘘初级通畅率显著低于无名静脉狭窄组(4/5比8/27,χ^(2)=6.974,P=0.008;6/8比8/27,χ^(2)=6.908,P=0.009)。Cox回归分析结果显示,中重度CVS及合并糖尿病是动静脉内瘘初级通畅的独立影响因素(分别HR=4.362,95%CI 1.644~11.574,P=0.003;HR=2.682,95%CI 1.624~4.431,P<0.001)。结论首次建立动静脉内瘘的CKD患者CVS的发生率较高,颈部透析用中心静脉导管留置时间≥3个月是CVS的独立危险因素,中重度CVS是动静脉内�Objective To study the incidence and risk factors of central vein stenosis(CVS)in chronic kidney disease(CKD)patients who received arteriovenous fistula(AVF)creation for the first time,as well as effects of CVS on patency of ipsilateral AVF.Methods It was a retrospective study.The CKD patients who received AVF creation for the first time in the First Affiliated Hospital of Zhengzhou University from January 2019 to August 2020,with central vein digital subtraction angiography(DSA)results prior to angioplasty were selected as the study subjects.The differences of incidence of CVS in CKD patients with/without a history of cervical catheterization and primary patency rates of AVF between CVS and non-CVS groups were compared.Logistic regression analysis method was applied to analyze the influencing factors of CVS in CKD patients.Kaplan-Meier method was used to analyze the primary patency rate of AVF.Cox regression analysis method was used to analyze the effect of CVS on the primary patency of ipsilateral AVF.Results A total of 283 CKD patients aged(50.45±14.76)years were enrolled in the study,including 165 males(58.3%).The dialysis age was 0.5(0,7.0)months.There were 55 patients(19.4%)diagnosed with CVS before AVF,including 39 patients with stenosis<50%and 16 patients with stenosis≥50%.The incidence of CVS in patients with history of right internal jugular vein central venous catheter insertion was significantly higher than that in those without this history[60.5%(26/43)vs.9.9%(15/151),χ^(2)=51.274,P<0.001].Multivariate logistic regression analysis results showed that hemodialysis catheters indwelling time≥3 months elevated the risk of CVS(OR=4.345,95%CI 1.540-12.263,P=0.006).A subset of 268 patients who had AVF creation ipsilateral to CVS were analyzed to determine the effects of CVS on patency of AVF.The median follow-up time was 34 months.The primary patency rate of AVF in the moderate to severe CVS group was significantly lower than that in the non-CVS group(5/7 vs.58/228,χ^(2)=7.720,P=0.005).The primary pa

关 键 词：肾透析 动静脉瘘 危险因素 中心静脉狭窄 长期通畅率 

分 类 号：R692[医药卫生—泌尿科学]