两种血管透析通路在慢性肾衰竭患者血液透析中的应用价值比较  

Comparison of the value of two vascular dialysis accesses in hemodialysis in patients with chronic renal failure

作　　者：房晓芳 贾利敏 赵翠 魏迪 杜书同 FANG Xiaofang;JIA Limin;ZHAO Cui;WEI Di;DU Shutong(Department of Nephrology,Cangzhou People′s Hospital,Cangzhou,Hebei 061000,China)

机构地区：[1]沧州市人民医院肾内科,河北沧州061000

出　　处：《检验医学与临床》2025年第7期925-930,935,共7页Laboratory Medicine and Clinic

基　　金：沧州市重点研发计划指导项目(172302122)。

摘　　要：目的分析慢性肾衰竭(CRF)血液透析中不同血管透析通路对透析效果的影响。方法选取2018年10月至2022年9月于该院接受血液透析的206例CRF患者为研究对象,按照随机数字表法分为A组和B组,各103例。A组采用自体动静脉内瘘(AVF),B组采用带隧道带涤纶套透析导管(TCC)。比较2组透析效果、免疫-炎症指标[白细胞介素-6(IL-6)、C反应蛋白(CRP)、诱导性T淋巴细胞(CD4^(+))比例、CD4^(+)/抑制性T淋巴细胞(CD8^(+))比值]、肾功能指标[尿素氮(BUN)、24 h尿蛋白定量(24 h Upro)、血肌酐(Scr)]、血栓弹力图(TEG)参数(α角、K值)、并发症、主要心血管不良事件(MACE)。结果透析6个月后,A组尿素清除指数(Kt/V)、尿素下降率(URR)明显高于B组,差异均有统计学意义(P<0.05)。重复测量方差分析结果显示:两组血清IL-6、CRP、CD4^(+)比例、CD4^(+)/CD8^(+)比值、BUN、24 h Upro、Scr、α角、K值存在交互效应、时间效应、组间效应,差异均有统计学意义(P<0.05)。多变量方差分析结果显示:A组透析1、3、6个月后血清IL-6、CRP水平低于B组,CD4^(+)比例、CD4^(+)/CD8^(+)比值高于B组,差异均有统计学意义(P<0.05)。A组透析1个月、3个月、6个月后BUN、24 h Upro、Scr高于B组,差异均有统计学意义(P<0.05)。A组透析1、3、6个月后α角低于B组,K值高于B组,差异均有统计学意义(P<0.05);A组并发症、MACE发生率分别为5.83%、4.85%,低于B组的15.53%、13.59%,差异均有统计学意义(P<0.05)。结论与TCC通路相比,AVF通路可提升CRF患者血液透析效果,改善患者肾功能,减轻机体炎症反应,调节TEG参数,降低并发症、MACE发生风险。Objective To investigate the effect of different vascular dialysis access on dialysis efficacy in chronic renal failure(CRF)patients undergoing hemodialysis.Methods A total of 206 patients with CRF who underwent vascular dialysis in Cangzhou People′s Hospital from October 2018 to September 2022 were selected for the study,and randomly divided into group A and group B,with 103 patients in each group.Group A was treated with autogenous arteriovenous fistula(AVF),and group B was treated with dialysis catheter with dacron jacket and tunnel(TCC).Dialysis outcomes,immuno-inflammatory indicators[interleukin-6(IL-6),C-reactive protein(CRP),induced T-lymphocytes cells(CD4^(+))proportion,CD4^(+)/suppressor T-lymphocytes cells(CD8^(+))ratio],renal function indicators[urea nitrogen(BUN),quantitative 24 h urinary proteins(24 h Upro),blood creatinine(Scr)]and thrombelastogram parameters(α-angle,K-value),complications and major adverse cardiovascular events(MACE)were compared between the two groups.Results After 6 months of dialysis,the urea clearance index(Kt/V)and urea reduction rate(URR)in group A were higher than those in group B(P<0.05).The results of repeated measures ANOVA showed that there were interaction effects,time effects and inter group effects in serum IL-6,CRP,CD4^(+)proportion,CD4^(+)/CD8^(+)ratio,BUN,24-hour Upro,Scr,α-angle,and K value between the two groups,and the differences were statistically significant(P<0.05).The results of multivariate analysis of variance showed that the levels of serum IL-6 and CRP in group A were lower than those in group B after dialysis for 1,3 and 6 months,while the CD4^(+)proportion and CD4^(+)/CD8^(+)ratio were higher than those in group B,and the differences were statistically significant(P<0.05).After 1 month,3 months and 6 months of dialysis,BUN,24-hour Upro and Scr in group A were higher than those in group B,and the differences were statistically significant(P<0.05).After 1,3,and 6 months of dialysis,theα-angle of group A was lower than that of group B,and the K valu

关 键 词：慢性肾衰竭 血液透析 自体动静脉内瘘 血栓弹力图 炎症 并发症 

分 类 号：R459.5[医药卫生—治疗学]