【摘要】 目的观察维持性血液透析(maintenance hemodialysis,MHD)患者血浆同型半胱氨酸(homocysteine,Hcy)、C反应蛋白(C-reactive protein,CRP)水平及透析低血压发生率等指标是否影响自体动静脉内瘘(autogenous arteriovenous fistulas,AVF)血栓的发生。方法选择以自体AVF为血管通路的MHD患者92例,观察1年是否有过1次或1次以上的内瘘血栓栓塞事件,将其分为AVF血栓组和非AVF血栓组。比较2组患者的透析中低血压发生率、Hcy、CRP、低密度脂蛋白(low density lipoprotein,LDL)、血浆白蛋白(albumin,Alb)、血红蛋白(hemoglobin,Hb)、红细胞比容(hematocrit value,Hct)、铁蛋白等1年内两次化验的平均值指标及透析时间,并进行相关危险因素分析。结果入选92例MHD患者的透析低血压发生率为19.6%(18/92),AVF血栓组和非AVF血栓组的透析低血压发生率比较,差异有统计学意义(P<0.05)。92例MHD患者Hcy异常发生率为100%,但2组患者的血浆Hcy水平差异无统计学意义,2组患者的CRP和铁蛋白水平差异也无统计学意义。危险因素分析提示Hb和透析低血压是AVF血栓形成的危险因素,Hcy、CRP不是AVF血栓形成的危险因素。AVF血栓组的透析时间及Hct低于非AVF血栓组,其差异有统计学意义(P<0.05),其他白细胞、SCr、血小板、LDL、Alb等生化指标的差异无统计学意义。结论透析低血压、Hb都是MHD患者AVF血栓发生的危险因素,而Hcy、CRP等与AVF血栓的发生无相关性。更多还原

【Abstract】 Objective To observe whether plasma homocysteine(Hcy),c-reactive protein(CRP) level and incidence of dialysis hypotension and other indicators influence the onset of autogenous arteriovenous internal fistula(AVF) thrombus in the maintenance hemodialysis(MHD) patients.Methods Nine-two cases of MHD patients with AVF vascular access were chosea The thrombus event of one time or over within one year was observed.The patients were divided into AVF thrombosis group and AVF non-thrombus group.The incidence of hypotension in dialysis,the average levels of Hcy,CRP,low density lipoprotein cholesterol(LDL-c),plasma albumin,hemoglobin(Hb),hematocrit(HCT) and ferritin by two tests within one year,and duration of dialysis were compared between two groups.The associated risk factors were analyzed.Results The incidence of dialysis hypotension in the 92 MHG patients was 19.6%(18/92).There was significant difference in the incidence of hypotension in dialysis between AVF thrombus group and AVF non-thrombosis group(P<0.05).The incidence of abnormal level of Hcy in 92 MHD patients was 100%,but there was no statistically significant difference in plasma Hcy levels between the two groups.There was no significant difference in CRP and ferritin levels between two groups.Hb and hypotension in dialysis were the risk factors for AVF thrombosis The duration of dialysis in AVF thrombus group(months) was significantly shorter than in AVF non-thrombus group(P<0.05).The HCT in AVF thrombus group was significantly lower than in AVF non-thrombus group(P<0.05).There were no significant differences in other indexes,such as white blood cells,SCr,platelets,LDL,Alb between two groups.Conclusions The hypotension in dialysis and Hb are the risk factors for AVF thrombosis in MHD patients,and Hcy and CRP are not correlated with occurrence of AVF thrombosis.更多还原