血清全段甲状旁腺激素水平对自体动静脉内瘘成熟的影响

doi:10.3969/j.issn.1004-583X.2022.12.005

摘要/Abstract

摘要：

目的探讨慢性肾衰竭(chronic renal failure, CRF)患者血清全段甲状旁腺激素(intact parathyroid hormone, iPTH)水平对自体动静脉内瘘(autogeneous arteriovenous fistule, AVF)成熟的影响。方法选取2019年1月至2022年5月于国药东风总医院肾脏内科住院并行AVF成形术患者108例,收集患者AVF成形术前一般资料、各项生化指标、双上肢动静脉彩色超声及术后2月桡动脉-头静脉瘘彩色超声。依据内瘘成熟情况分为AVF成熟组与AVF成熟不良组,分析两组术前一般资料、各项生化指标及影像学资料对AVF成熟的影响。结果与AVF成熟不良组比较,AVF成熟组年龄较小、合并糖尿病占比较少、使用钙离子拮抗剂占比较少,血清iPTH、高敏C反应蛋白水平较低,头静脉内径较大,差异均有统计学意义(P<0.05)。多因素Logistc回归分析显示,年龄、高敏C反应蛋白、头静脉内径均是影响AVF成熟的独立危险因素(均P<0.05)。结论年龄、高敏C反应蛋白、头静脉内径均是AVF成熟的独立危险因素。iPTH水平升高与AVF成熟不良相关。

关键词: 肾功能衰竭, 慢性, 血清全段甲状旁腺激素, 自体动静脉内瘘

Abstract:

Objective To investigate the effect of serum intact parathyroid hormone (iPTH) level on the maturation of autogeneous arteriovenous fistula (AVF) in patients with chronic renal failure (CRF). Methods A total of 108 patients treated with AVF angioplasty in the Nephrology Department of Sinopharm Dongfeng General Hospital from January 2019 to May 2022 were recruited. Their baseline characteristics, biochemical data, color ultrasound reports of arteries and veins of both upper limbs and those of radial artery cephalic vein fistula at 2 months postoperatively were collected. Patients were assigned into AVF maturation group and AVF malmaturation group. The influence of clinical data on the maturation of AVF was analyzed. Results Compared with patients in the AVF malmaturation group, patients in the AVF maturation group were significantly younger, and the incidence of diabetes was significantly lower (P<0.05). Moreover, the use of calcium antagonists was significantly less frequent (P<0.05). Serum iPTH and high-sensitivity C-reactive protein were significantly lower in the AVF maturation group (P<0.05). The diameter of cephalic vein was significantly larger than that of AVF malmaturation group (P<0.05). Multivariate Logistic regression analysis showed that age, high-sensitivity C-reactive protein and head vein diameter were independent risk factors for AVF maturation (all P<0.05). Conclusion Age, high sensitivity C-reactive protein and head vein diameter are independent risk factors for AVF maturation. Elevated iPTH levels are associated with poor AVF maturation.

Key words: kidney failure, chronic, serum intact parathyroid hormone, autogeneous arteriovenous fistula

中图分类号:

R692.5

汪朋瑞, 陈华茜, 杨涛, 赵黎, 李蓬. 血清全段甲状旁腺激素水平对自体动静脉内瘘成熟的影响[J]. 临床荟萃, 2022, 37(12): 1094-1098.

Wang Pengrui, Chen Huaqian, Yang Tao, Zhao Li, Li Peng. The effect of serum intact parathyroid hormone level on the maturation of autogeneous arteriovenous fistula[J]. Clinical Focus, 2022, 37(12): 1094-1098.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.12.005

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I12/1094

图/表 4

参考文献 32

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组别	例数	性别(例)		年龄 (岁)	合并糖尿病 (例)	使用钙离子拮抗剂 (例)
组别	例数	男	女	年龄 (岁)	合并糖尿病 (例)	使用钙离子拮抗剂 (例)
AVF成熟组	85	52	33	57.69±13.07	32	58
AVF成熟不良组	23	14	9	67.83±11.42	15	20
统计值		χ²=0.027		t=3.382	χ²=2.407	χ²=2.129
P值		0.979		0.001	0.018	0.039

组别	例数	性别(例)		年龄 (岁)	合并糖尿病 (例)	使用钙离子拮抗剂 (例)
组别	例数	男	女	年龄 (岁)	合并糖尿病 (例)	使用钙离子拮抗剂 (例)
AVF成熟组	85	52	33	57.69±13.07	32	58
AVF成熟不良组	23	14	9	67.83±11.42	15	20
统计值		χ²=0.027		t=3.382	χ²=2.407	χ²=2.129
P值		0.979		0.001	0.018	0.039

组别	例数		iPTH (pg/ml)		hs-CRP (mg/L)		血红蛋白 (g/L)		中性粒细胞/ 淋巴细胞比值		血小板/ 淋巴细胞比值		ALB (g/L)
AVF成熟组	85		137.44±74.61		1.92±1.45		92.11±16.09		4.73±3.84		205.92±181.28		34.36±3.27
AVF成熟不良组	23		193.10±122.07		6.20±2.99		90.74±17.74		4.79±3.18		189.40±94.06		34.17±5.56
t值			2.084		6.651		-0.354		0.077		-0.421		-0.157
P值			0.047		0.000		0.724		0.939		0.675		0.876
组别		例数		血清钙(mmol/L)		血清磷(mmol/L)		TC(mmol/L)		TG(mmol/L)		LDL-C(mmol/L)
AVF成熟组		85		2.09±0.15		1.47±0.45		3.96±1.17		1.36±0.78		1.94±0.90
AVF成熟不良组		23		2.05±0.15		1.57±0.55		3.71±0.85		1.22±0.38		2.03±0.81
t值				-1.221		0.870		-0.969		-1.223		0.428
P值				0.225		0.386		0.335		0.225		0.670

组别	例数		iPTH (pg/ml)		hs-CRP (mg/L)		血红蛋白 (g/L)		中性粒细胞/ 淋巴细胞比值		血小板/ 淋巴细胞比值		ALB (g/L)
AVF成熟组	85		137.44±74.61		1.92±1.45		92.11±16.09		4.73±3.84		205.92±181.28		34.36±3.27
AVF成熟不良组	23		193.10±122.07		6.20±2.99		90.74±17.74		4.79±3.18		189.40±94.06		34.17±5.56
t值			2.084		6.651		-0.354		0.077		-0.421		-0.157
P值			0.047		0.000		0.724		0.939		0.675		0.876
组别		例数		血清钙(mmol/L)		血清磷(mmol/L)		TC(mmol/L)		TG(mmol/L)		LDL-C(mmol/L)
AVF成熟组		85		2.09±0.15		1.47±0.45		3.96±1.17		1.36±0.78		1.94±0.90
AVF成熟不良组		23		2.05±0.15		1.57±0.55		3.71±0.85		1.22±0.38		2.03±0.81
t值				-1.221		0.870		-0.969		-1.223		0.428
P值				0.225		0.386		0.335		0.225		0.670

组别	例数	头静脉内径 (mm)	肱动脉内径 (mm)	肱动脉血流量 (cm/s)	桡动脉内径 (mm)	桡动脉血流量 (cm/s)
AVF成熟组	85	2.42±0.51	4.09±0.53	71.36±22.03	2.34±0.42	58.21±16.09
AVF成熟不良组	23	2.07±0.40	3.94±0.58	66.30±13.70	2.20±0.30	53.48±14.94
t值		-3.120	-1.192	-1.046	-1.600	-1.270
P值		0.002	0.236	0.298	0.113	0.207