不同类型血管通路对维持性血液透析患者微炎症状态的影响

发布时间：2018-01-05 17:42

本文关键词：不同类型血管通路对维持性血液透析患者微炎症状态的影响　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨不同血管通路对维持性血液透析(MHD)患者C-反应蛋白(CRP)水平以及微炎症状态的影响。方法:采用横断面研究,共纳入220例MHD患者。根据MHD患者血管通路分为自体动静脉内瘘(AVF)组及带隧道带涤纶套导管(TCC)组。其中AVF组138例,TCC组83例。AVF组男性93例,女性45例,平均年龄为(51.7±14.2)岁。TCC组男性54例,女性28例,平均年龄(60.4±15.4)。通过检测血清超敏C反应蛋白(hs-CRP)、血清白蛋白、总钙、磷、全段甲状旁腺激素、透析前后尿素氮、肌酐、尿酸、血清铁蛋白、转铁蛋白饱和度,并计算钙磷乘积、尿素清除指数(Kt/v)、尿素下降率(URR),分析不同血管通路对血清hs-CRP的影响。结果:TCC组hs-CRP明显高于AVF组,两组间hs-CRP差异有统计学意义(P0.05)。两组年龄、白蛋白、肌酐差异有统计学意义(P0.05)。白蛋白、转铁蛋白饱和度与hs-CRP呈负相关,有统计学意义(r=-0.182,r=-0.187,P=0.007,P=0.005)。尿酸与hs-CRP相关性有统计学意义,呈正相关(r=0.188,P=0.005)。多元逐步回归分析显示血管通路是hs-CRP的独立影响因素(F=26.238,P0.001),带隧道带涤纶套导管是hs-CRP水平升高的独立危险因素。结论:不同血管通路可以影响维持性血液透析患者CRP水平,带隧道带涤纶套导管可能是维持性血液透析患者发生微炎症状态的原因之一。
[Abstract]:Objective: to investigate the effects of different vascular pathways on the level of C-reactive protein (CRP) and microinflammation in patients with maintenance hemodialysis (MHD). Two hundred and twenty patients with MHD were divided into two groups according to the vascular pathway of MHD: autogenous arteriovenous fistula (AVF) group and MHD group (AVF group). There were 93 males and 45 females in TCC group. The average age was 51.7 卤14.2 years old. There were 54 males and 28 females in TCC group. The mean age was 60.4 卤15.40.The serum hypersensitive C-reactive protein hs-CRP, serum albumin, total calcium, phosphorus, total parathyroid hormone, urea nitrogen and creatinine were detected before and after dialysis. Uric acid, serum ferritin, transferrin saturation, calcium and phosphorus product, urea clearance index (KT / vN), urea decline rate (URR). The effects of different vascular pathways on serum hs-CRP were analyzed. Results the hs-CRP of AVF group was significantly higher than that of AVF group. The difference of hs-CRP between the two groups was statistically significant (P 0.05). There were significant differences in age, albumin and creatinine between the two groups (P 0.05). There was a negative correlation between transferrin saturation and hs-CRP. The correlation between uric acid and hs-CRP was statistically significant, and there was a positive correlation between uric acid and hs-CRP. Multiple stepwise regression analysis showed that vascular pathway was an independent factor of hs-CRP. Conclusion: different vascular pathways can affect the CRP level of maintenance hemodialysis patients. Tunneling with polyester duct may be one of the causes of microinflammation in maintenance hemodialysis patients.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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