维持性血液透析患者动静脉瘘功能障碍的危险因素：一项横断面研究。

The risk factors for arteriovenous fistula dysfunction in maintenance hemodialysis patients: A cross-sectional study.

机构信息

Department of Nephrology, Beijing Haidian Hospital, Beijing Haidian section of Peking University Third Hospital, Beijing, China.

Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China.

出版信息

Hemodial Int. 2024 Apr;28(2):170-177. doi: 10.1111/hdi.13145. Epub 2024 Mar 6.

DOI:10.1111/hdi.13145

PMID:38448796

Abstract

INTRODUCTION

Arteriovenous fistula (AVF) dysfunction is a prevalent complication among maintenance hemodialysis patients. However, the factors influencing AVF patency remain unclear. To address this, we conducted a study aimed at identifying factors contributing to AVF dysfunction in this patient population.

METHODS

The study compared clinical data, vascular calcification score, and laboratory data focusing on blood cell composition and coagulation in 100 maintenance hemodialysis patients in whom an AVF had been inserted from January through September of 2022. The patients were divided into a group in which the AVF functioned without issues and a group in which the AVF was dysfunctional, defined as not able to provide a blood flow of greater than 200 mL/min.

FINDINGS

Patients in the 2 groups (56 in the dysfunctional AVF group and 44 in the group with satisfactory AVF function) were similar demographically. Compared with the normally functioning AVF group, the AVF dysfunction group exhibited significantly higher Agatston calcium scores (20.5 [1.28, 298] median [Q1, Q3] vs. 1.14 [0.00, 11.6]; p = 0.01), elevated triglyceride levels (1.1 [0.6, 1.2] mmol/L vs. 0.5 [0.3, 0.8]; p < 0.01), increased prothrombin activity (113 ± 22.1% vs. 99.4 ± 23.1; p < 0.01), lower prothrombin time (10.4 [9.8, 10.8] s vs. 11.0 [10.3, 11.5]; p < 0.01), higher red blood cell (RBC) counts (3.5 ± 0.7 · 10/L vs. 3.0 ± 0.7; p < 0.01), and elevated hemoglobin levels (98.0 ± 21.8 g/L vs. 84.9 ± 24.2; p < 0.01). Higher C-reactive protein (20.2 [3.3, 20.2] mg/L vs. 17.8 [6.2, 17.8]; p = 0.01) and procalcitonin levels (0.9 [0.4, 0.9] ng/mL vs. 0.5 [0.2, 0.7]; p < 0.01) were also noted. Logistic regression analysis indicated that platelet/lymphocyte ratio, monocyte/lymphocyte ratio, and RBC count were factors associated with AVF dysfunction. Increased monocyte/lymphocyte ratio and RBC count correlated with higher risk, while a higher platelet/lymphocyte ratio was associated with lower risk.

DISCUSSION

Arteriovenous fistula dysfunction in maintenance hemodialysis patients is associated with higher proportions of specific hematological parameters, particularly elevated RBC count, and altered platelet/lymphocyte and monocyte/lymphocyte ratios.

摘要

简介

动静脉瘘（AVF）功能障碍是维持性血液透析患者中普遍存在的并发症。然而，导致 AVF 通畅性受损的因素仍不清楚。为了解决这个问题，我们进行了一项研究，旨在确定影响这一患者群体中 AVF 功能障碍的因素。

方法

该研究比较了 2022 年 1 月至 9 月期间接受 AVF 植入的 100 名维持性血液透析患者的临床数据、血管钙化评分以及血液细胞成分和凝血的实验室数据。患者被分为 AVF 功能正常组和 AVF 功能障碍组，后者定义为不能提供大于 200ml/min 的血流。

结果

两组患者（AVF 功能障碍组 56 例，AVF 功能正常组 44 例）在人口统计学上相似。与 AVF 功能正常组相比，AVF 功能障碍组的 Agatston 钙评分明显更高（20.5 [1.28, 298]中位数[Q1, Q3]与 1.14 [0.00, 11.6]；p=0.01），甘油三酯水平升高（1.1 [0.6, 1.2]mmol/L 与 0.5 [0.3, 0.8]mmol/L；p<0.01），凝血酶原活性增加（113±22.1%与 99.4±23.1%；p<0.01），凝血酶原时间缩短（10.4 [9.8, 10.8]s 与 11.0 [10.3, 11.5]s；p<0.01），红细胞（RBC）计数升高（3.5±0.7·10/L 与 3.0±0.7；p<0.01），血红蛋白水平升高（98.0±21.8 g/L 与 84.9±24.2 g/L；p<0.01）。C 反应蛋白（20.2 [3.3, 20.2] mg/L 与 17.8 [6.2, 17.8]mg/L；p=0.01）和降钙素原水平（0.9 [0.4, 0.9]ng/mL 与 0.5 [0.2, 0.7]ng/mL；p<0.01）也较高。