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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。
Objective To investigate whether plasma homocysteine (Hcy) level, C-reactive protein (CRP) level and the incidence of dialysis hypotension in patients with maintenance hemodialysis (MHD) Fistula (autogenous arteriovenous fistulas, AVF) thrombosis. Methods Ninety-two MHD patients with autologous AVF as vascular access were enrolled in this study. The incidence of one or more endovascular thromboembolic events at one year was observed and divided into AVF thrombosis group and non-AVF thrombus group. The incidences of hypotension, Hcy, CRP, low density lipoprotein (LDL), albumin (Alb), hemoglobin (Hb), hematocrit value , Hct), ferritin and other two tests within 1 year mean indicators and dialysis time, and analysis of risk factors. Results The incidence of dialysis hypotension in 92 patients with MHD was 19.6% (18/92). There was significant difference in dialysis hypotension between AVF thrombosis group and non-AVF thrombosis group (P <0.05). The incidence of abnormal Hcy in 92 patients with MHD was 100%. There was no significant difference in plasma Hcy levels between the two groups. There was no significant difference in CRP and ferritin between the two groups. Analysis of risk factors suggest that Hb and dialysis hypotension is a risk factor for AVF thrombosis, Hcy, CRP is not a risk factor for AVF thrombosis. The hemodialysis time and Hct in AVF thrombosis group were lower than those in non-AVF thrombosis group, and the difference was statistically significant (P <0.05). There were no significant differences in the other biochemical indexes of other white blood cells, SCr, platelets, LDL and Alb. Conclusion Dialysis hypotension, Hb are risk factors for AVF thrombosis in patients with MHD, and Hcy, CRP and other AVF thrombosis no correlation.