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目的:对维持性血液透析患者动静脉内瘘功能与左心室功能的相关性进行分析。方法:选取我院肾脏病血液净化科2011-2012年收治的维持性血液透析治疗患者138例,进行前瞻性队列研究。对所有患者均常规检测各项生化指标;利用超声稀释法检测内瘘功能、血流动力学指标;利用彩色多普勒检测内瘘侧头静脉及桡动脉血管直径及血流量,利用超声心动图检查评价左心室功能,随访观察18~30个月。结果:内瘘血流量<600ml/min患者34例,内瘘血流量>600ml/min患者104例,不同内瘘血流量患者内瘘功能及左心室功能指标差异无统计学意义。多因素Logistic回归分析显示,血浆白蛋白与超敏C反应蛋白水平是患者左室收缩功能障碍的危险因素,而年龄、血清胆固醇水平、内瘘侧头静脉和桡动脉直径是患者左室舒张功能障碍的危险因素。Cox回归模型提示,性别、甲状旁腺激素以及超敏C反应蛋白是患者死亡的独立危险因素。结论:维持性血液透析治疗患者普遍存在左心室肥厚,而内瘘流量与心功能之间尚不存在明确的因果关系。
Objective: To analyze the correlation between arteriovenous fistula and left ventricular function in maintenance hemodialysis patients. Methods: A total of 138 patients undergoing maintenance hemodialysis admitted to our department of nephrology and blood purification department from 2011 to 2012 were enrolled in the prospective cohort study. All the patients were routinely tested for biochemical indicators; fistula function and hemodynamic parameters were detected by ultrasonic dilution; the diameter and blood flow of fistula and radial artery of fistula were detected by color Doppler, and the echocardiography Examination and evaluation of left ventricular function, follow-up observation of 18 to 30 months. Results: There were 34 patients with internal fistula blood flow <600ml / min and 104 patients with internal fistula blood flow> 600ml / min. There was no significant difference in fistula function and left ventricular function between different fistula blood flow. Multivariate logistic regression analysis showed that plasma albumin and high-sensitivity C-reactive protein were risk factors for left ventricular systolic dysfunction in patients. Age, serum cholesterol level, fistula and radial artery diameter were the patients with left ventricular diastolic function Obstacle risk factors. Cox regression models suggest that gender, parathyroid hormone, and high-sensitivity C-reactive protein are independent risk factors for death in patients. Conclusions: Left ventricular hypertrophy is common in patients undergoing maintenance hemodialysis and there is no clear causal relationship between fistula flow and cardiac function.