血红蛋白变异性与自体动静脉内瘘功能障碍的相关性分析  

Correlation Between Hemoglobin Variability and Arteriovenous Fistula Dysfunction

作　　者：李向莲 范晓栋 莫立稳 肖丹 成红 程悦 Li Xianglian;Fan Xiaodong;Mo Liwen(Department of Nephrology,General Hospital of Western Theater Command of PLA,Chengdu,Sichuan 610083,China)

机构地区：[1]中国人民解放军西部战区总医院肾脏病科,四川成都610083 [2]成都市新都区第三人民医院血液净化中心,四川成都610504

出　　处：《四川医学》2025年第4期422-426,共5页Sichuan Medical Journal

基　　金：西部战区总医院科研项目(编号:2021XZYG-C38)。

摘　　要：目的探讨血液透析患者血红蛋白(Hb)变异性与自体动静脉内瘘(AVF)功能障碍发生的相关性。方法回顾性分析中国人民解放军西部战区总医院血液透析中心2021年9月至2023年3月经自体动静脉内瘘行维持性血液透析的患者,分为内瘘功能障碍组和无功能障碍组。收集患者的基本资料、血液指标、6个月内血红蛋白均值、血红蛋白标准差、血红蛋白变异系数。通过单因素分析和Logistic多因素分析,发现影响AVF功能障碍发生的相关因素。结果最终纳入187例患者,内瘘功能障碍组42例,无内瘘功能障碍组145例。两组患者性别、年龄、透析龄、原发病是否为糖尿病肾病、观察期前是否接受过AVF手术干预、血钙、血磷、甲状旁腺激素(PTH)、铁蛋白、促红细胞生成素(EPO)用量、Hb均数之间比较,差异无统计学意义(P>0.05)。内瘘功能障碍组白蛋白水平低于无功能障碍组(P=0.017);内瘘功能障碍组Hb标准差高于无功能障碍组(P=0.037);内瘘功能障碍组Hb变异系数高于无功能障碍组(P=0.003)。多因素Logistic分析发现,随着Hb变异系数的增加,内瘘功能障碍发生率增高(OR=1.277,95%CI 1.019~1.601,P=0.034)。结论高Hb变异性是动静脉内瘘功能发生障碍的危险因素,维持平稳的Hb水平可减少动静脉内瘘功能障碍的发生。Objective To investigate the correlation between hemoglobin(Hb)variability and arteriovenous fistula(AVF)dysfunction in hemodialysis patients.Methods A retrospective analysis was conducted on patients undergoing maintenance hemodialysis via AVF in General Hospital of Western Theater Command of PLA hemysisodial center from September 2021 to March 2023.Patients were divided into AVF dysfunction and non-dysfunction groups.Basic patient information,blood indices,and Hb mean,standard deviation,and coefficient of variation over 6 months were collected.Univariate and Logistic multivariate analyses were performed to identify the related factors associated with AVF dysfunction.Results A total of 187 patients were included,with 42 in the AVF dysfunction group and 145 in the non-dysfunction group.No significant differences were observed between the two groups in terms of gender,age,dialysis duration,primary disease(diabetic kidney disease),history of AVF surgical intervention,blood calcium,blood phosphorus,parathyroid hormone(PTH),ferritin,erythropoietin(EPO)dosage,or mean Hb(P>0.05).However,the albumin level in the AVF dysfunction group was lower than that in the non-dysfunction group(P=0.017).The Hb standard deviation(P=0.037)and the Hb variability(P=0.003)in the AVF dysfunction group was higher than those in the non-dysfunction group.Multivariate Logistic regression analysis showed that the incidence of AVF dysfunction increased in patients with higher Hb variability(OR=1.277,95%CI 1.019~1.601,P=0.034).Conclusion High hemoglobin variability is a risk factor for AVF dysfunction,and maintaining stable hemoglobin level can reduce the incidence of AVF dysfunction.

关 键 词：血红蛋白变异性 动静脉内瘘 血液透析 

分 类 号：R459.5[医药卫生—治疗学]