降钙素原与维持性血液透析患者自体动静脉内瘘 并发症的关系研究

目的 探讨降钙素原（PCT）与维持性血液透析（MHD）患者自体动静脉内瘘（AVF）并发症的关系。方法 选取使用AVF行MHD治疗的患者186例，根据随访过程中超声检查AVF是否出现并发症［狭窄和（或）血栓］分为并 发症组48例和非并发症组138例，收集2组患者透析龄、透析中收缩压下降≥30 mmHg（1 mmHg=0.133 kPa）例数、穿 刺失败或血肿形成例数、是否合并糖尿病等临床资料，并检测2组患者PCT、C反应蛋白（CRP）、血小板（Plt）等指标， 比较2组间上述指标的差异，应用二元Logistic回归分析AVF并发症的影响因素。结果 并发症组合并糖尿病、血液 透析中收缩压下降≥30 mmHg、穿刺失败或血肿形成发生率及PCT、CRP、透析龄高于非并发症组（P＜0.05）。2组性 别、年龄、原发疾病、尿素清除指数、体质量指数、每月血液灌流及血液透析滤过时间等比较差异无统计学意义。二 元Logistic回归分析发现，较高水平的PCT、血液透析中收缩压下降≥30 mmHg、穿刺失败或血肿形成是发生AVF并发 症的独立危险因素（P＜0.05）。结论 高水平PCT是MHD患者AVF并发症发生的危险因素，临床应重视对微炎症状 态的改善，并注意合理控制血压，避免血液透析中血压快速下降，不断提高穿刺技术。

The relationship between procalcitonin and complications of autogenous arteriovenous fistula in patients with maintenance hemodialysis

Objective To investigate the relationship between procalcitonin (PCT) and complications of autogenous arteriovenous fistula (AVF) in patients with maintenance hemodialysis (MHD). Methods A total of 186 patients treated with AVF for MHD were selected. According to whether the complications stenosis and/or thrombosis] of AVF were detected by ultrasound during the follow-up, 48 cases were divided into the complication group and 138 cases were divided into the non-complication group. Clinical data of patients in the two groups were collected, including dialysis age, the number of patients with systolic blood pressure decline ≥30 mmHg (1 mmHg=0.133 kPa), the number of patients with puncture failure or hematoma formation, and the number of patients with diabetes. PCT, C-reactive protein (CRP) and platelets (Plt) were also detected. The indicators were compared between the two groups. Binary Logistic regression analysis was performed to analyze the related influencing factors of AVF complications. Results The incidence of diabetes mellitus, systolic blood pressure drop ≥30 mmHg, puncture failure or hematoma formation, PCT, CRP, dialysis age were significantly higher in the complication group than that in the non-complication group (P＜0.05). There were no significant differences in gender, age, primary disease, Kt/V, BMI, monthly hemoperfusion and hemodiafiltration time between the two groups (P＞0.05). Logistic regression analysis showed that higher levels of PCT, systolic blood pressure drop≥30 mmHg, puncture failure or hematoma formation in hemodialysis were the risk factors for the complications of AVF (P＜0.05). Conclusion High level PCT is an independent risk factor for AVF complications in MHD patients. Clinical attention should be paid to the improvement of microinflammation, reasonable control of blood pressure to avoid rapid decline in hemodialysis and continuous improvement of puncture technique.