目的 横断面调查2020年海南省维持性血液透析(maintenance hemodialysis,MHD)≥3月患者自体动静脉内瘘动脉瘤(autologous arteriovenous fistula aneurysm,AVFA)的患病率及部分临床影响因素。方法 调查2020年3月海南省以自体动静脉内瘘为血管通路的MHD患者肾脏原发病、年龄、性别、透析龄、AVFA类型，AVFA最大直径、最长长度及穿刺方式，进行AVFA患病率及相关风险研究。 结果 ①海南省MHD患者AVFA患病率为41.22%(1050/2547)，以II、III型为主(分别占54.29%、35.14%)。②I型AVFA与性别(OR =1.373,95% CI：0.906～2.080，P =0.135)、年龄(青年与老年相比OR =1.730,95% CI：0.702～4.263，P =0.234；中年与老年相比OR=0.848,95% CI：0.342～2.104，P =0.722；年轻老年与老年相比OR=0.995,95% CI：0.391～2.534，P=0.992)和穿刺方式无关(扣眼穿刺与局域穿刺相比OR =1.081,95% CI：0.568～2.056，P =0.812；绳梯穿刺与局域穿刺相比OR=0.778,95% CI：0.461～1.313，P =0.347)；原发病是高血压的患者发生I型AVFA的风险是其他原发病的3.9倍(95% CI：1.255～12.107；P =0.019)；随着透析龄的增长AVFA的发生风险增加(透析龄4年及以上者是透析龄1年者的3.85倍，95% CI：0.146～0.463，P＜0.001；透析龄4年及以上者是透析龄2年者的3.25倍，95% CI：0.175～0.541，P＜0.001；透析龄4年及以上者是透析龄3年者的2.58倍，95% CI：0.208～0.721，P=0.003)。③II型AVFA与年龄(青年与老年相比OR=0.734,95% CI：0.459～1.174，P=0.197；中年与老年相比OR=1.004,95% CI：0.647～1.559， P=0.986；年轻老年与老年相比OR=1.119,95% CI：0.710～1.762，P=0.629)和原发病(肾炎与其他相比OR=1.173,95% CI：0.796～1.731，P=0.420；高血压与其他相比OR=1.227,95% CI：0.761～1.977，P =0.401；糖尿病与其他相比OR=0.884,95% CI：0.568～1.377，P=0.586；多囊肾与其他相比OR=1.421,95% CI：0.732～2.759，P=0.299)无关；局域穿刺发生AVFA的风险最高，分别是扣眼穿刺的4.27倍(95% CI：0.153～0.357；P＜0.001)，绳梯穿刺的1.73倍(95% CI：0.452～0.742；P＜0.001)；随着透析龄的增长AVFA发生的风险增加，透析4年以上发生II型AVFA的风险是透析1年的1.39倍(95% CI：0.048～0.108；P＜0.001)。④III型AVFA比较复杂，与透析龄(透析龄4年及以上者是透析龄1年者的37.04倍， 95% CI： 0.013～0.055，P＜0.001；透析龄4年及以上者是透析龄2年者的5.95倍，95% CI：0.117～0.241， P＜0.001；透析龄4年及以上者是透析龄3年者的3.28倍，95% CI：0.213～0.439，P＜0.001)、性别 (OR =2.004,95% CI：1.522～2.638，P＜0.001)及穿刺方式(扣眼穿刺与局域穿刺相比OR=0.201,95% CI：0.120～0.338，P＜0.001；绳梯穿刺与局域穿刺相比OR=0.591,95% CI：0.439～0.796，P＜0.001)有关，原发病是其他的患者III型AVFA的发生风险是糖尿病的2.55倍(95% CI：0.222～0.691；P=0.001)；青年是老年患者发生III型AVFA风险的2.11倍(95% CI：1.127～3.957；P=0.020)。 结论 海南省MHD患者AVFA患病率为41.2%，以Valentini II、III型为主，避免局域穿刺可有效延缓其发生发展。
Objectives To investigate the prevalence of autologous arteriovenous fistula aneurysm (AVFA) and the related clinical symptoms in patients with maintenance hemodialysis (MHD) for ≥3 months in Hainan province in 2020. Methods A cross-sectional survey was conducted to investigate the renal primary disease, age, gender, dialysis vintage, AVFA type, maximum diameter and length of the AVFA, and cannulation method in MHD patients using autologous arteriovenous fistula as the vascular access in Hainan province in March 2020. The prevalence of AVFA and the risk factors for AVFA were then derived. Results ①The prevalence of AVFA in MHD patients in Hainan province was 41.2%, with the type II AVFA of 54.3% and type III AVFA of 35.1% in the AVFA patients. ②The prevalence of type I AVFA was not correlated with sex, age and AVF puncture method. Patients with hypertension as the primary kidney disease had 3.9 times higher risk of developing type I AVFA than the patients with other primary kidney diseases. The risk of developing type I AVFA increased with increasing dialysis vintage. ③The prevalence of type II AVFAs was not correlated with age and primary kidney disease. Patient with local puncture had the highest prevalence of type II AVFA, being 4.27 times higher than that of buttonhole puncture and 1.73 times higher than that of rope ladder puncture. The risk of developing type II AVFA increased with increasing dialysis vintage; the risk of developing type II AVFA was 1.39 times higher in patient with dialysis vintage of ≥4 years than in patients with dialysis vintage of one year. ④Type III AVFA was relatively complex. The prevalence of type III AVFA correlated with sex, dialysis vintage and AVF puncture method. The risk of developing type III AVFA was 2.55 times higher in patients with other primary kidney disease than in patients with the primary kidney disease of diabetic nephropathy. The risk of developing type III AVFA was 2.11 times higher in young adults than in older patients. Conclusion The prevalence of AVFA was 41.2% in MHD patients in Hainan province, with Valentini II and III as the dominant types. Avoiding local puncture can effectively delay the occurrence and development of Valentini II and III AVFAs.
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