代谢综合征对血液透析通路通畅性的影响。
The influence of metabolic syndrome on hemodialysis access patency.
机构信息
Yale University School of Medicine, New Haven, CT 06520-8089, USA.
出版信息
J Vasc Surg. 2012 Dec;56(6):1656-62. doi: 10.1016/j.jvs.2012.05.104. Epub 2012 Sep 5.
OBJECTIVE
The natural history of patients with metabolic syndrome (MetS) undergoing hemodialysis access placement is unknown. MetS has previously been found as a risk factor for poor outcomes for vascular surgery patients undergoing other interventions. The aim of this is study is to describe the outcomes of MetS patients undergoing primary hemodialysis access placement.
METHODS
The medical records of the 187 patients who underwent hemodialysis access placement between 1999 and 2009 at the Veterans Administration Connecticut Healthcare System were reviewed. Survival, primary patency, and secondary patency were evaluated using the Gehan-Breslow test for survival. MetS was defined as the presence of three or more of the following: blood pressure≥130/90 mm Hg; triglycerides≥150 mg/dL; high-density lipoprotein≤50 mg/dL for women and ≤40 mg/dL for men; body mass index≥30 kg/m2; or fasting blood glucose≥110 mg/dL.
RESULTS
Of the 187 patients who underwent hemodialysis access placement, 115 (61%) were identified to have MetS. The distribution of MetS factors among all patients was hypertension in 98%, diabetes in 58%, elevated triclyceride in 39%, decreased high-density lipoprotein in 60%, elevated body mass index in 36%, and 39% were currently receiving hemodialysis. Patients were a mean age of 66 years. The median length of follow-up was 4.2 years. The forearm was site of fistula placement in 53%; no difference existed between groups (MetS, 57%; no MetS, 50%; P=.388). The median time to primary failure was 0.46 years for all patients (MetS, 0.555 years; no MetS, 0.436 years; P=.255). Secondary patency was 50% at 1.18 years for all patients (no MetS, 1.94 years; MetS, 0.72 years; P=.024). Median survival duration for all patients was 4.15 years (no MetS, 5.07 years; MetS, 3.63 years; P=.019).
CONCLUSIONS
MetS is prevalent among patients undergoing hemodialysis access placement. Patients with MetS have equivalent primary patency rates; however, their survival and cumulative patency rates are significantly lower than in patients without MetS. Patients with MetS form a high-risk group that needs intensive surveillance protocols.
目的
代谢综合征（MetS）患者行血液透析通路建立的自然病史尚不清楚。MetS 先前被发现是血管手术患者接受其他干预措施后预后不良的危险因素。本研究旨在描述 MetS 患者行初次血液透析通路建立的结局。
方法
回顾了 1999 年至 2009 年间在退伍军人事务康涅狄格医疗保健系统接受血液透析通路建立的 187 例患者的病历。采用 Gehan-Breslow 检验对生存、初次通畅率和二次通畅率进行评估。MetS 的定义为以下三种或三种以上情况的存在：血压≥130/90mmHg；甘油三酯≥150mg/dL；女性高密度脂蛋白≤50mg/dL，男性≤40mg/dL；体重指数≥30kg/m2；或空腹血糖≥110mg/dL。
结果
在接受血液透析通路建立的 187 例患者中，115 例（61%）被确定为 MetS。所有患者中 MetS 因素的分布为高血压 98%，糖尿病 58%，甘油三酯升高 39%，高密度脂蛋白降低 60%，体重指数升高 36%，39%正在接受血液透析。患者的平均年龄为 66 岁。中位随访时间为 4.2 年。前臂为瘘管放置部位占 53%；两组之间无差异（MetS 组为 57%，非 MetS 组为 50%；P=.388）。所有患者初次失败的中位时间为 0.46 年（MetS 组为 0.555 年，非 MetS 组为 0.436 年；P=.255）。所有患者的二次通畅率为 1.18 年时 50%（非 MetS 组为 1.94 年，MetS 组为 0.72 年；P=.024）。所有患者的中位生存时间为 4.15 年（非 MetS 组为 5.07 年，MetS 组为 3.63 年；P=.019）。
结论
MetS 在接受血液透析通路建立的患者中很常见。MetS 患者的初次通畅率相当；然而，他们的生存和累积通畅率明显低于非 MetS 患者。MetS 患者形成了一个高危群体，需要强化监测方案。
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