维持性血液透析患者自体动静脉内瘘失功危险因素的Meta 分析

郑雯雯; 鲁春红; 戴小梅; 黄丽璇; 吕桂兰

doi:10.3969/j.issn.1671-4091.2019.10.012

中国血液净化 >

2019 , Vol. 18 >Issue 10: 705 - 709

DOI: https://doi.org/10.3969/j.issn.1671-4091.2019.10.012

血管通路

维持性血液透析患者自体动静脉内瘘失功危险因素的Meta 分析

郑雯雯 ,
鲁春红 ,
戴小梅 ,
黄丽璇 ,
吕桂兰

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1. 南京大学附属金陵医院（东部战区总医院）国家肾脏临床研究中心全军肾脏病研究所血液净化中心 2. 南京大学医学院护理专业

收稿日期: 2019-03-18

修回日期: 2019-05-07

网络出版日期: 2019-09-27

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Risk factors for autologous arteriovenous fistula dysfunction in hemodailysis patients: a meta analysis

ZHENG Wen-Wen ,
LU Chun-Hong ,
DAI Xiao-Mei ,
HUANG Li-Xuan ,
HUANG Li-Xuan Gui-Lan

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1Blood PurificationCenter, Jinling Hospital, Nanjing University School of Medicine, and Eastern General Hospital, National Kidney
Disease Clinical Research Center & Nephrology Research Center of PLA, Nanjing 210002, China; 2Department of Nursing, School of Medicine, Nanjing University, Nanjing 210093, China

Received date: 2019-03-18

Revised date: 2019-05-07

Online published: 2019-09-27

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摘要

【摘要】目的探讨维持性血液透析(maintenance hemodialysis, MHD)患者发生自体动静脉内瘘(arteriovenous fistulas, AVF)的危险因素，为自体动静脉内瘘失功的预防及诊断提供依据与参考。方法计算机检索The Cochrane Library、PubMed、Medline、Web of Science、CNKI、WanFang、VIP，搜集建库至2019 年2 月关于MHD 患者发生自体动静脉内瘘失功影响因素的文献，利用RevMan 5.3 软件进行Meta 分析。结果共纳入20 篇文献，累计2873 例患者。Meta 分析结果，AVF 失功的各危险因素的合并OR 值或MD 值(95% CI，P) 分别为：年龄4.39(1.43～7.34，P=0.004)、合并糖尿病2.53(1.89～3.39，P＜0.001)、原发病为糖尿病肾病2.26(1.69～3.04,P＜0.001)、发生低血压2.90(1.17～7.16, P=0.020)、C 反应蛋白15.75(14.51～16.99,P＜0.001)、血磷0.27 (0.22～0.32,P＜0.001)、甲状旁腺激素93.95(92.21～95.68,P＜0.001)、血红蛋白- 2.5(- 3.70～- 1.31,P＜0.001)、白细胞1 (0.08～1.93,P=0.030)、血小板23.55(1.10～45.99,P=0.040)。结论高龄、合并糖尿病、原发病为糖尿病肾病、低血压的发生、C 反应蛋白、血磷、甲状旁腺激素、白细胞、血小板水平高是血液透析患者动静脉内瘘失功能发生的危险因素，血红蛋白是其保护因素，应针对血液透析人群中存在的AVF 失功的可控危险因素进行早期干预。

关键词： 维持性血液透析; 自体动静脉内瘘失功; 危险因素; Meta 分析

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郑雯雯 , 鲁春红 , 戴小梅 , 黄丽璇 , 吕桂兰 . 维持性血液透析患者自体动静脉内瘘失功危险因素的Meta 分析[J]. 中国血液净化, 2019 , 18(10) : 705 -709 . DOI: 10.3969/j.issn.1671-4091.2019.10.012

Abstract

【Abstract】Objective To explore the risk factors for arteriovenous fistula (AVF) dysfunction in hemodialysis patients in order to provide the basis for early identification of AVF dysfunction. Methods We searched databases including Cochrane Library, PubMed, Medline, Web of Science, CNKI, WanFang Data, and VIP from inception to February 2017 to collect the risk factors for AVF dysfunction in adult patients. RevMan 5.3 software was used for meta-analysis. Results A total of 2,873 cases were included. Meta analysis showed that the combined OR value or MD value (95% CI, P value) of the risk factors for AVF dysfunction were age 4.39(1.43~7.34, P=0.004), combined diabetes 2.53(1.89~3.39, P<0.001), primary diabetic nephropathy 2.2(1.69~3.04, P＜0.001), occurrence of hypotension 2.90 (1.17~7.16, P=0.020), C- reactive protein 15.75(14.51~16.99, P＜0.001), serum phosphorus 0.27(0.22~0.32, P<0.001), parathyroid hormone 93.95(92.21~95.68, P<0.001), hemoglobin -2.5(-3.70~-1.31, P<0.001), white blood cells (0.08~1.93, P=0.030), and platelet 23.55 (1.10～45.99, P=0.040). Conclusion Older age, diabetes mellitus, diabetic nephropathy as the primary disease, the occurrence of hypotension, and higher levels of C-reactive protein, blood phosphorus, parathyroid hormone, white blood cells and platelet were the risk factors for AVF dysfunction in hemodialysis patients; hemoglobin is a protection factor. Therefore, clinical measures should be focused on the early intervention of the controllable risk factors for AVF dysfunction.

Key words： Maintenance hemodialysis; Arteriovenous fistulas; Risk factor; Meta analysis

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