目的 探讨终末期肾病患者腹主动脉钙化(abdominal aortic calcification,AAC)与自体动静脉内瘘(arteriovenous fistula,AVF)成熟不良的相关性，及自体动静脉内瘘成熟不良的影响因素。 方法 收集2021年10月—2022年10月在新乡医学院第一附属医院肾脏病医院首次行AVF成形术并定期进行随访的慢性肾脏病(chronic kidney disease,CKD)5期患者，收集患者的一般资料、血液学资料、AAC评分(AAC score，AACs)情况、手术前和手术后彩超检查资料。根据内瘘术后物理检查情况、临床使用、手术后彩超数据将患者分为内瘘成熟组及未成熟组，对比2组资料之间的差异。多因素Logistic回归分析法分析AVF成熟不良的影响因素。 结果 本研究共纳入160例患者，内瘘成熟组(n=118)与未成熟组(n=42)患者在年龄(t=4.078，P＜0.001)、糖尿病病史(χ 2=4.050，P=0.044)、AACs(t=7.056，P＜0.001)、全段甲状旁腺激素(iPTH)(t=2.151，P=0.035)等方面差异有统计学意义。单因素Logistic回归分析结果显示年龄(OR=1.102，95% CI:1.042～1.166，P=0.001)、糖尿病病史(OR=2.807，95% CI:1.010～7.803，P=0.048)、AACs(OR=1.559，95% CI:1.269～1.915，P＜0.001)、iPTH(OR=1.002，95% CI:1.000～1.005，P=0.040)均与内瘘成熟不良相关，多因素Logistic回归分析结果显示年龄(OR=1.073，95% CI:1.007～1.142，P=0.030)、AACs(OR=1.478，95% CI:1.197～1.825，P＜0.001)是CKD 5期患者发生AVF成熟不良的独立影响因素。 结论 年龄和AACs是动静脉内瘘成熟不良的独立影响因素，在内瘘评估中应考虑上述因素对内瘘成熟的影响。
Objective To explore the relationship between abdominal aortic calcification (AAC) and poor maturation of autologous arteriovenous fistula (AVF), and the influencing factors for poor maturation of AVF. Methods Patients with chronic kidney disease (CKD) at stage 5 and undergoing AVF construction for the first time at the First Affiliated Hospital of Xinxiang Medical university from October 2021 to October 2022 were enrolled in this study. Their general clinical data, hematological findings, AAC score, and preoperative and postoperative ultrasound examination results were collected. Patients were then divided into immature group and mature group according to physical examination, clinical use, and color Doppler ultrasound results after AVF surgery. Multivariate logistic regression was used to analyze the influencing factors for poor maturation of AVF. Results A total of 160 patients were included, with the age of 49.78±14.17 years old and 67.5% of males. There were statistically significant differences in age (t=4.078, P＜0.001), diabetes history (χ 2=4.050, P=0.044), AAC score (t=7.056, P＜0.001) and iPTH (t=2.151, P=0.035) between the two groups. Univariate logistic regression showed that age (OR=1.102, 95% CI 1.042～1.166, P=0.001), diabetes history (OR=2.807, 95% CI 1.010～7.803, P=0.048), AAC score (OR=1.559, 95% CI 1.269～1.915, P＜0.001) and iPTH (OR=1.002, 95% CI 1.000～1.005, P=0.040) were associated with poor maturation of AVF. Multivariate logistic regression showed that age (OR=1.073, 95% CI 1.007～1.142, P=0.030) and AAC score (OR=1.478, 95% CI 1.197～1.825, P＜0.001) were the independent influencing factors for poor maturation of AVF in CKD patients at stage 5. Conclusions Our study demonstrates that age and AAC score were the independent influencing factors for poor maturation of AVF. Therefore, age and AAC score should be considered in the evaluation of AVF maturation after operation.
[1]Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 update[J]. Am J Kidney Dis, 2020, 75(4 Suppl 2): S1?S164.
[2][2]中国医院协会血液净化中心分会血管通路工作组．中国血液透析用血管通路专家共识(第2版)[J]．中国血液净化，2019，18 (6)：365—381．
[3]Duque JC, Tabbara M, Martinez L, et al. Dialysis Arteriovenous Fistula Failure and Angioplasty: Intimal?Hyperplasia and Other Causes of Access Failure. Am J Kidney Dis. 2017, 69(1):147-151.
[4]Honkanen E, Kauppila L, Wikstr?m B, et al. CORD study group. Abdominal aortic calcification in dialysis patients: results of the CORD study. Nephrol Dial Transplant. 2008, 23(12):4009-15.
[5]Allon M, Robbin ML, Umphrey HR, et al. Preoperative arterial microcalcification and clinical outcomes of arteriovenous fistulas for hemodialysis[J]. Am J Kidney Dis, 2015, 66(1): 84 ? 90.
[6]Cheung AK, Imrey PB, Alpers CE, et al. Intimal Hyperplasia, Stenosis, and Arteriovenous Fistula Maturation Failure in the Hemodialysis Fistula Maturation Study. J Am Soc Nephrol.2017;28(10):3005-3013.
[7]Jeong S, Kwon H, Chang JW, Kim MJ, Ganbold K, Han Y, Kwon TW, Cho YP. Comparison of outcomes between type 2 diabetic and non-diabetic incident hemodialysis patients with functioning arteriovenous fistulas. Medicine (Baltimore). 2019, 98(48):e18216.
[8] Li HL, Chan YC, Cui D, et al. Predictors of primary functional maturation of autogenous radiocephalic arteriovenous fistula in a cohort of Asian patients[J]. Ann Vasc Surg, 2020, 66: 326 ? 333.
[9] Shanahan CM, Crouthamel MH, Kapustin A, et al. Arterial calcification in chronic kidney disease: key roles for calcium and phosphate[J]. Circ Res, 2011, 109(6): 697 ? 711.
[10]Kra?niak A, Drozdz M, Pasowicz M, et al. Factors involved in vascular calcification and atherosclerosis in maintenance haemodialysis patients[J]. Nephrol Dial Transplant, 2007, 22(2): 515?521.
[11]Kubiak RW, Zelnick LR, Hoofnagle AN, et al. Hemodialysis Fistula Maturation Study Group. Mineral Metabolism Disturbances and Arteriovenous Fistula Maturation. Eur J Vasc Endovasc Surg. 2019 May;57(5):719-728.
[12]Woodside KJ, Bell S, Mukhopadhyay P, et al. Arteriovenous fistula maturation in prevalent hemodialysis patients in the United States: a national study[J]. Am J Kidney Dis, 2018, 71 (6): 793?801.
