摘要
目的探讨主动脉弓钙化(aortic arch calcification,AoAC)与动静脉内瘘(arteriovenous fistula,AVF)失功的相关关系。方法回顾性选取2016年9月至2017年9月间在宁夏医科大学总医院接受AVF术并行维持性血液透析(maintenance hemodialysis,MHD)的患者为研究对象。采用胸部X线评估AoAC程度。依据AoAC评分将患者分为4组(0~3级)。随访并统计患者AVF失功次数至AVF术后2年或患者退出血液透析或死亡。Spearman相关分析法分析AoAC评分与内瘘失功的相关关系。多因素Logistic回归分析法分析AVF失功的影响因素。结果165例MHD患者入选本研究,年龄(55.52±14.06)岁,男性102例(61.82%)。AoAC发生128例(77.6%),其中1级钙化组45例(27.3%),2级钙化组35例(21.2%),3级钙化组48例(29.1%)。钙化组和非钙化组(0级钙化)年龄、脉压差、糖尿病比例、校正钙、血磷、舒张压、全段甲状旁腺素及AVF失功例次等的差异均有统计学意义(均P<0.05)。Spearman相关分析结果显示,AoAC评分与内瘘失功(r=0.759,P=0.010)、年龄(r=0.407,P<0.001)、脉压差(r=0.575,P=0.006)、糖尿病病史(r=0.848,P=0.049)、血钙(r=0.591,P=0.018)和血磷(r=0.509,P=0.012)呈正相关,与舒张压呈负相关(r=-0.614,P=0.013)。多因素Logistic回归分析结果显示,糖尿病病史(OR=6.702,95%CI 1.431~31.396,P=0.016)、高校正钙(OR=10.830,95%CI 3.479~35.300,P=0.008)、高血磷(OR=3.792,95%CI 1.128~12.750,P=0.031)和AoAC(OR=4.473,95%CI 1.490~13.428,P=0.008)是MHD患者AVF失功的独立影响因素。结论AoAC为MHD患者发生AVF失功的独立危险因素,AoAC程度的评估对AVF失功具有预测价值。
Objective To explore the relationship between aortic arch calcification(AoAC)and arteriovenous fistula(AVF)failure in maintenance hemodialysis(MHD)patients.Methods The patients who underwent initial AVF and started MHD in the General Hospital of Ningxia Medical University from September 2016 to September 2017 were retrospectively recruited and prospectively followed up until two years after AVF surgery or withdrawal from MHD or death.Calcification of the aortic arch was estimated with plain chest radiology.The patients were divided into four groups(0-3 grade)according to the aortic arch calcification score(AoACs).Spearman correlation analysis was used to analyze the relationship between AoACs and AVF failure.Multivariate logistic regression was used to analyze the influencing factors of AVF failure.Results A total of 165 MHD patients were included in this study,with age of(55.52±14.06)years old and 102 males(61.82%).Among 128 AoAC patients(77.6%),45 patients were categorized as grade 1(27.3%),35 patients as grade 2(21.2%)and 48 patients as grade 3(29.1%).There was significant difference in the,age,pulse pressure,corrected calcium,phosphorus,diastolic blood pressure,intact parathyroid hormone and AVF failure between AoAC group and no AoAC group(grade 0 calcification)(all P<0.05).The results of Spearman correlation analysis showed that AoACs was positively correlated with AVF failure(r=0.759,P=0.010),age(r=0.407,P<0.001),pulse pressure(r=0.575,P=0.006),and diabetes history(r=0.848,P=0.049),blood calcium(r=0.591,P=0.018),and blood phosphorus(r=0.509,P=0.012),and negatively correlated with diastolic blood pressure(r=-0.614,P=0.013).Multivariate logistic regression analysis showed that diabetes history(OR=6.702,95%CI 1.431-31.396,P=0.016),high corrected calcium(OR=10.830,95%CI 3.479-35.300,P=0.008),high phosphorus(OR=3.792,95%CI 1.128-12.750,P=0.031)and AoAC(OR=4.473,95%CI 1.490-13.428,P=0.008)were the independent influencing factors of AVF failure.Conclusions AoAC is an independent risk factor for AVF failure in MHD
作者
叶建华
殷效龙
郭晓燕
张汀
陈孟华
Ye Jianhua;Yin Xiaolong;Guo Xiaoyan;Zhang Ting;Chen Menghua(Department of Nephrology,General Hospital of Ningxia Medical University,Yinchuan 750001,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2022年第1期9-14,共6页
Chinese Journal of Nephrology
基金
宁夏回族自治区自然科学基金(2021AAC03360)
宁夏医科大学科学研究基金资助项目(XZ2015023)。
关键词
肾透析
主动脉弓
动静脉瘘
血管钙化
Renal dialysis
Aortic arch
Arteriovenous fistula
Vascular calcification
