移植物动静脉内瘘血栓形成的流行病学特征、干预效果及影响因素分析
Analysis of epidemiological characteristics,intervention effects and influencing factors of arteriovenous graft thrombosis
刘文静 1王宇飞 1张倍豪 1王欣芳 1王瑞敏 1薛小玲 1梁献慧 1王沛1
作者信息
- 1. 郑州大学第一附属医院血液净化中心,郑州 450052
- 折叠
摘要
目的 探究移植物动静脉内瘘(arteriovenous graft,AVG)血栓形成的流行病学特征、干预效果及影响因素,为优化血液透析患者血管通路方案提供参考.方法 该研究为回顾性研究,选取2018年1月至2022年12月在郑州大学第一附属医院血液净化中心建立AVG的患者,收集其临床资料及通路随访资料.根据患者随访期间AVG是否形成血栓分为血栓组和非血栓组,分析AVG血栓形成的流行病学情况、影响因素及干预后通畅率.AVG随访至2023年6月30日或患者死亡或失访或AVG废弃.采用Kaplan-Meier法分析AVG通畅率并绘制生存曲线,Log-rank检验比较组间通畅率的差异.采用Logistic回归模型分析AVG血栓形成的影响因素.结果 该研究纳入464例患者的475个 AVG,年龄(55.50±11.85)岁,男性 193例(40.6％),糖尿病 185例(38.9％),透析龄24(1,68)个月.随访时间为602(380,920)d,154个(32.4％)AVG共发生307例次AVG血栓事件,标化发生率为0.34次/患者年,其中60例次(19.5％,60/307)为频繁血栓事件.Kaplan-Meier生存分析结果显示血栓组(84.0％比 92.5％,P=0.017;66.5％比 85.7％,P＜0.001)及频繁血栓亚组(78.9％比 92.5％,P=0.030;54.6％比85.7％,P＜0.001)AVG 2年和3年二期通畅率均显著低于无血栓组.269例次AVG血栓事件的治疗被纳入干预效果分析,215例次(79.9％)采用腔内介入手术干预,54例次(20.1％)采用杂交手术(腔内介入+外科手术)干预,技术成功率为98.9％(266/269),临床成功率为98.1％(264/269).Kaplan-Meier生存分析结果显示,腔内介入组和杂交手术组90d、365 d干预后一期通畅率的差异均无统计学意义(均P＞0.05),180d干预后一期通畅率的差异有统计学意义(45.1％比26.5％,Z=2.563,P=0.015).多因素Logistic回归分析结果显示,移植物类型(以Intering组为参照,Propaten组OR=1.953,95％CI 1.139～3.350,P=0.015;Acuseal组 OR=2.628,95％CI 1.438～4.800,P=0.002)、体重指数＜18.5 kg/m2(以18.5～24.0 kg/m2组为参照,OR=0.291,95％CI 0.090～0.943,P=0.040)、血清白蛋白＜40 g/L(OR=1.579,95％CI 1.019～2.445,P=0.041)、血清铁蛋白＜200 µg/L(OR=1.818,95％CI 1.162～2.845,P=0.009)及平均动脉压＜70 mmHg(OR=7.180,95％CI 1.339～38.501,P=0.021)为AVG血栓形成的独立影响因素.结论 AVG血栓事件的标化发生率为0.34次/患者年,主要集中在少数患者.血栓形成降低AVG的二期通畅率.AVG血栓经腔内介入手术或杂交手术处理有较高的技术成功率和临床成功率.血栓形成可能与移植物类型、患者营养状况及平均动脉压相关.
Abstract
Objective To investigate the epidemiology features,intervention effects and influencing factors of thrombosis in arteriovenous graft(AVG),and to provide reference for optimizing vascular access scheme in hemodialysis patients.Methods It was a retrospective study.The clinical and follow-up data of patients with AVG constructed in the Blood Purification Center,the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2022 were analyzed.According to whether AVG thrombosis occurred during the follow-up period,they were divided into thrombosis group and non-thrombosis group,and the epidemiology status,influencing factors and patency rates of AVG thrombosis were analyzed.AVG was followed up until June 30,2023 or abandonment or death of patient or loss of follow-up.Kaplan-Meier method was used to analyze the patency rates of AVG.Log-rank test was used to compare the differences of patency rates between groups.Logistic regression model was used to analyze the influencing factors of AVG thrombosis.Results The study included 475 AVG from 464 patients,with age of(55.50±11.85)years old,193 males(40.6％),185 diabetes patients(38.9％)and dialysis age of 24(1,68)months.One hundred and fifty-four AVG(32.4％)had a total of 307 AVG thrombotic events during the follow-up of 602(380,920)days,with a standardized incidence of 0.34 times per patient-year.Among them,60 cases(19.5％,60/307)had frequent thrombosis.Kaplan-Meier survival analysis showed that AVG secondary patency rates at 2-years and 3-years in the thrombosis group and frequent thrombosis subgroup were inferior to those in the non-thrombosis group(84.0％vs.92.5％,P=0.017;66.5％vs.85.7％,P＜0.001;78.9％vs.92.5％,P=0.030;54.6％vs.85.7％,P＜0.001).Two hundred and sixty-nine AVG thrombotic events were analyzed to evaluate the treatment effects.Endovascular interventional surgery was used for thrombectomy in 215 cases(79.9％),and hybrid surgery(endovascular interventional surgery combined with surgical incision)was used in 54 cases(20.1％),with a technical success rate of 98.9％(266/269)and a clinical success rate of 98.1％(264/269).Kaplan-Meier survival analysis showed that there were no statistically significant differences in the primary post-intervention patency rates at 90 days and 365 days,respectively(all P＞0.05),and there was statistically significant difference in the primary post-intervention patency rate at 180 days(45.1％vs.26.5％,Z=2.563,P=0.015).Multivariate logistic regression analysis showed that graft-applied type(intering as the reference,propaten OR=1.953,95％CI 1.139-3.350,P=0.015;acuseal OR=2.628,95％CI 1.438-4.800,P=0.002),body mass index＜18.5 kg/m2(18.5-24.0 kg/m2 as the reference,OR=0.291,95％CI 0.090-0.943,P=0.040),serum albumin＜40 g/L(OR=1.579,95％CI 1.019-2.445,P=0.041),serum ferritin＜200 μg/L(OR=1.818,95％CI 1.162-2.845,P=0.009)and mean arterial pressure＜70 mmHg(OR=7.180,95％CI1.339-38.501,P=0.021)were the independent influencing factors of AVG thrombosis.Conclusions The incidence of AVG thrombotic events is 0.34 times per patient-year,mainly concentrated in a small number of patients.Thrombosis reduces the secondary patency rate of AVG.AVG thrombosis treatment with endovascular interventional surgery or hybrid surgery has a high technical success rate and a clinical success rate.The thrombosis is related to graft-applied types,nutritional status of patients and mean arterial pressure level.
关键词
动静脉瘘/血栓形成/肾透析/移植物动静脉内瘘/通畅率Key words
Arteriovenous fistula/Thrombosis/Renal dialysis/Arteriovenous graft/Patency rate引用本文复制引用
出版年
2024
NETL
NSTL
万方数据