摘要
目的:探讨不同类型长期血管通路对维持性血液透析(MHD)患者预后的影响。方法:本研究为回顾性队列研究。采用按地区分层抽样的方法从全国血液净化病例信息登记系统(CNRDS)中选取2016-01-01至2016-12-31河北省MHD患者。根据长期血管通路的类型分为动静脉内瘘组和隧道式导管组,Kaplan-Meier方法绘制生存曲线,COX回归模型分析不同类型长期血管通路与MHD患者全因死亡和心血管事件死亡的关系。结果:共纳入研究对象4 766例,动静脉内瘘组4 285例(89.9%),隧道式导管组481例(10.1%)。共982例患者死亡,其中心血管事件死亡344例(35.0%)。Kaplan-Meier生存分析结果显示,隧道式导管组患者全因死亡率(χ^(2)=109.334,P<0.001)与心血管事件死亡率(χ^(2)=60.362,P<0.001)均显著高于动静脉内瘘组。多因素Cox回归模型结果显示,在校正混杂因素后,隧道式导管组患者发生全因死亡的风险是动静脉内瘘组的1.598倍(HR=1.598,95%CI 1.164~2.194,P=0.004),发生心血管事件死亡的风险是动静脉内瘘组的1.894倍(HR=1.894,95%CI 1.241~2.889,P=0.003)。结论:不同类型长期血管通路与MHD患者的预后密切相关,隧道式导管是MHD患者全因死亡及心血管事件死亡的独立危险因素。
Objective:To investigate the effects of different long-term vascular access on prognosis of maintenance hemodialysis(MHD) patients. Methodology:The study was a retrospective cohort study. The method of stratified sampling by region was used to select MHD patients in Hebei Province from January 1, 2016 to December 31, 2016 from Chinese National Renal Data System(CNRDS). According to the type of long-term vascular access, patients were divided into arteriovenous fistula group and tunnel-cuffed catheter group. Survival was estimated by Kaplan-Meier method. Cox regression model was used to analyze effect of different types long-term vascular access on prognosis of MHD patients.Results:A total of 4 766 patients were enrolled, including 4 285 patients(89.9%) in arteriovenous fistula group and 481 patients(10.1%) in tunnel-cuffed catheter group. 982 patients died, and the main cause of death was cardiovascular events(344, 35.0%). Kaplan-Meier survival analysis showed that the all-cause survival rate(χ^(2)=109.334, P<0.001) and cardiovascular survival rate(χ^(2)=60.362, P<0.001) of patients in arteriovenous fistula group were significantly higher than those of tunnel-cuffed catheter group. Multivariate COX regression analysis showed that after adjusting for confounding factors, the risk ratio of all-cause deaths in tunnel-cuffed catheter group was 1.598 times that in arteriovenous fistula group(HR=1.598, 95%CI 1.164~2.194,P=0.004),and the risk ratio of cardiovascular death was 1.894 times that of arteriovenous group(HR=1.894, 95%CI 1.241~2.889, P=0.003). Conclusion:Different long-term vascular access types are closely related to the prognosis of MHD patients. Tunnel-cuffed catheter is an independent risk factor for all-cause death and cardiovascular death in MHD patients.
作者
胡春燕
张海霞
靳晶晶
程美娟
张胜雷
白亚玲
徐金升
HU Chunyan;ZHANG Haixia;JIN Jingjing;CHENG Meijuan;ZHANG Shenglei;BAI Yaling;XU Jinsheng(Hebei Clinical Research Center for Chronic Kidney Disease,Hebei Key Laboratory of Vascular Calcification in Kidney Disease,Department of Nephrology,The Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2021年第6期525-529,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
河北省医学技术跟踪项目(G2018050)
河北省重点研发计划项目(20377704D)
河北省科技计划项目(16397733D)。
关键词
维持性血液透析
血管通路
预后
maintenance hemodialysis
vascular access
prognosis
