【摘要】目的比较不同血管通路类型的维持性血液透析(maintenance hemodialysis,MHD)患者的临床特征及全因死亡差异。方法回顾性收集2010 年5 月31 日～2016 年12 月31 日于大连大学附属中山医院开始接受长期MHD 患者310 例，随访截止时间为2020 年7 月31 日，随访终点为全因死亡、血管通路并发症事件和新发心脑血管事件。比较自体动静脉内瘘组(autologous arteriovenous fistula，AVF)和带隧道和涤纶套的透析导管组(tunnel-cuffed catheter，TCC)患者的临床资料、实验室指标、心脏超声参数及全因死亡差异。结果共纳入310 例MHD 患者，男性184 例(59.4%)，年龄(65.69±13.11)岁。2 组患者开始透析年龄及原发病构成比较，差异有统计学意义(t=-3.134，P=0.002；χ2=11.792，P=0.007)。TCC 组肾性贫血发生率高于AVF 组(χ2=5.120，P=0.024)，AVF 组肺动脉高压(pulmonary arterial hypertension，PAH)发生率高于TCC 组(χ2=4.696，P=0.030)；经过50.00(25.00,73.25)月随访，219 例患者死
亡，男性(HR=1.384, 95% CI:1.042～1.839, P=0.025)、开始透析年龄(HR=1.036,95% CI:1.023～1.049, P=0.001)、心血管疾病史(HR=1.698, 95% CI:1.244～2.318, P=0.001)、使用TCC 血液透析(HR=2.264, 95% CI:1.703～3.009, P=0.001)、糖尿病肾病(HR= 1.734, 95%CI:1.322～2.275,P=0.001)是MHD 患者全因死亡的独立危险因素。结论AVF 组肺动脉高压发生率更高，TCC 组肾性贫血发生率较高，使用TCC 透析、开始透析年龄、既往心血管疾病史、原发病糖尿病肾病是MHD 患者全因死亡的独立危险因素。
【Abstract】Objective To compare the clinical characteristics and all-cause mortality of maintenance hemodialysis (MHD) patients with different vascular access types. Methods A retrospective collection of 310 MHD patients started receiving MHD in affiliated Zhongshan Hospital of Dalian University from May 31, 2010 to December 31, 2016. The follow-up deadline was July 31, 2020. The endpoint events were all-cause death, complications of vascular access, and cardiovascular and cerebrovascular events. The differences in clinical data, laboratory indexes, cardiac ultrasound parameters, and all-cause mortality rate of patients in the
autogenous arteriovenous fistula (AVF) group and the tunnel- cuffed catheter (TCC) group were compared. Results A total of 310 MHD patients were enrolled, with 184 males (59.4%), and the mean age was 65.69±13.11 years old. The age of starting dialysis and the primary cause of end-stage renal disease were different between groups (t=- 3.134, P=0.002;χ2=11.792, P=0.007). Compare with the AVF group, patients in the TCC group with a higher rate of anemia (χ2=5.120，P=0.024) and a lower rate of pulmonary hypertension (χ2=4.696, P=0.030). The incidence of pathway complications and cardiovascular death was not statistically significant (P>0.05). After 50.00 (25.00, 73.25) months of follow-up, 219 patients died. The independent risk factors of
all-cause death including male gender (HR=1.384, 95% CI:1.042～1.839, P=0.025), the age of starting dialysis (HR=1.036, 95% CI: 1.023～1.049, P=0.001), the history of cardiovascular disease (HR=1.698, 95% CI: 1.244～2.318, P=0.001), use catheter (HR= 2.264, 95% CI:1.703～3.009, P=0.001), diabetic nephropathy (HR=1.734, 95% CI:1.322～2.275, P=0.001). Conclusion Patients in the TCC group with a higher rate of anemia and a lower rate of pulmonary hypertension. Use catheter, the age of starting dialysis, history of cardiovascular disease, and diabetic nephropathy were independent risk factors of all-cause death in our MHD patients.
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