目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者血管钙化(vascular calcification,VC)程度与自体动静脉内瘘(arteriovenous fistula,AVF)失功的关系。方法 选取2019年1月—2020年1月在桂林医学院附属医院肾内科首次行自体动静脉内瘘手术的患者共166例。收集入选患者的一般资料及实验室检查数据，根据其建立内瘘时的冠状动脉钙化积分(coronary artery calcification score,CACS)分为无钙化组、轻度钙化组、中度钙化组、重度钙化组。分析CACS相关的临床因素和AVF失功的危险因素，并观察2年内钙化患者与无钙化患者自体动静脉内瘘的初级通畅率。 结果 共入选MHD患者166例，无钙化组92例，轻度钙化组33例，中度钙化组19例，重度钙化组22例。单因素分析显示年龄(H=4.877,P=0.017),糖尿病病史(c2=9.083,P=0.028),舒张压(H=17.037,P=0.001),血钙(H=12.260,P=0.007),全段甲状旁腺激素(H=9.698,P=0.021)在冠状动脉钙化4组间比较有统计学差异。多因素COX分析回归显示：静脉直径(HR=0.432,95% CI：0.262～0.712,P=0.001)是AVF失功的保护因素，Spearman相关分析显示AVF失功与体质量指数(r=0.214,P=0.006)、白蛋白(r=0.173,P=0.026)、血小板/淋巴细胞比值(platelet/lymphocyte ratio,PLR)(r=0.159,P=0.041)、静脉直径(r=0.231, P=0.003)呈正相关；第 6个月、12 个月、18个月、24个月AVF 通畅率分别为71.69%、60.24%、50%、40.96%。Kaplan-Meier生存分析显示有无钙化对AVF通畅率的影响无统计学差异(Log Rank c2=2.407,P=0.121)。 结论 不同程度的冠状动脉钙化对2年内AVF失功无影响。
Objective To investigate the relationship between the degree of vascular calcification (VC) and arteriovenous fistula (AVF) dysfunction in patients with maintenance hemodialysis (MHD). Methods A total of 166 patients subjected to standard arteriovenous fistula surgery for the first time in the Department of Nephrology, The Affiliated Hospital of Guilin Medical College from January 2019 to January 2020 were selected. Their general clinical information and laboratory examinations were collected. According to the coronary artery calcification score (CACS) at the time of AVF surgery, the patients were divided into non-calcification group, mild calcification group, moderate calcification group and severe calcification group. The clinical factors relating to CACS and the risk factors for AVF dysfunction were analyzed. The primary patency rate of AVF in 2 years in the patients with and without VC was observed. Results A total of 166 MHD patients were enrolled including 92 cases in no calcification group, 33 cases in mild calcification group, 19 cases in moderate calcification group, and 22 cases in severe calcification group. Univariate analysis showed that age (H=4.877, P=0.017), diabetes (c2=9.083, P=0.028), diastolic blood pressure (H=17.037, P=0.001), serum calcium (H=12.260, P=0.007) and intact parathyroid hormone (H=9.698, P=0.021) were statistically different among the four groups (P＜0.05). Multivariate Cox regression showed that venous diameter (HR=0.496, 95% CI:0.317～0.777, P=0.001) was an protective factor for AVF dysfunction. Spearman correlation analysis showed that AVF dysfunction was positively correlated with BMI(r=0.214,P=0.006), albumin(r=0.173,P=0.026), platelet/lymphocyte ratio (PLR r =0.214,P=0.006) and venous diameter(r=0.231,P=0.003). The patency rates were 71.69%, 60.24%, 50% and 40.96% after the surgery for 6 months, 12 months, 18 months and 24 months. Kaplan-Meier survival curve of the primary patency period showed that VC did not affect the patency rate of AVF (log rank test, χ2=2.407, P=0.121). Conclusions The degrees of coronary artery calcification had no effect on AVF dysfunction in two years after surgery.
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