【摘要】目的 探讨维持性血液透析患者动静脉内瘘栓塞的影响因素。方法 以46例首次发生动静脉内瘘栓塞的患者为病例组，按1：2选择与其同期行动静脉内瘘术且入组时内瘘功能仍良好的患者92例为对照组。收集两组的各项临床和生化指标，分别进行单因素分析、logistic回归分析及生存分析。结果 单因素分析显示两组之间年龄、糖尿病、内瘘部位、血管吻合方式、透析次数、透析时间、低血压、血红蛋白、血细胞比容、血小板、甘油三酯、钙磷乘积、心脑血管并发症、使用左卡尼汀等存在差异；logistic回归分析显示患有糖尿病和钙磷乘积高是内瘘栓塞的危险因素，使用左卡尼汀是保护因素；生存分析显示使用左卡尼汀者动静脉内瘘的中位生存时间为496天，未使用者为272天，两者之间差异显著（P=0.001）。结论 糖尿病、钙磷乘积与动静脉内瘘血栓形成相关，长期使用左卡尼汀可以延长动静脉内瘘的使用寿命。

【Abstract】Objective To investigate the influential factors of thrombosis in native arteriovenous fistula (AVF) in maintenance hemodialysis patients. Methods 46 patients were recruited as case group when their AVF were thrombed at the first time. 92 patients whose AVF were conducted at the same time with the ratio 2:1 of each matched case were also recruited as control group. The clinical and biochemical data of the two groups were analyzed by analysis of variance, binary logistic regression analysis and survival analysis. Result Age, diabetes, AVF location, anastomosis, hemodialysis frequency, hemodialysis time, hypotension, hemoglobin, hematocrit, platelet, triglyceride, calcium-phosporous product, cardio-cerebrovascular disease and carnitine were statistically significant difference between the two groups. By logistic regression analysis, diabetes and calcium-phosporous product were the risk factors of AVF thrombosis, but carnitine was the protective factor. The median survival of AVF was 496 days for patients who had regularly injected carnitine, while for the non-carnitine injected patients the median survival time was 272 days, p value was 0.001. Conclusion Diabetes and calcium-phosporous product could be the risk factors of AVF thrombosis, and carnitine injected may be a protective factor.