| 王旭,汪楠,吴国仲,等.阿托伐他汀对合并有糖尿病的终末期肾病病人动静脉内瘘功能的影响研究[J].安徽医药,2023,27(9):1877-1881. |
| 阿托伐他汀对合并有糖尿病的终末期肾病病人动静脉内瘘功能的影响研究 |
| A study of the effect of atorvastatin on arteriovenous fistula function in patients with end-stage renal disease complicated with diabetes mellitus |
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| DOI：10.3969/j.issn.1009-6469.2023.09.041 |
| 中文关键词: 糖尿病肾病 尿毒症 阿托伐他汀 肾透析 终末期肾病 动静脉内瘘 |
| 英文关键词: Diabetic nephropathies Uremia Atorvastatin Renal dialysis End-stage renal disease Arteriovenous fistula |
| 基金项目:安徽医科大学科学研究基金( 2018xkj077) |
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| 中文摘要: |
| 目的研究阿托伐他汀对合并有糖尿病的终末期肾病病人动静脉内瘘( AVF)的功能影响。方法回顾性收集 2018年 1月至 2019年 12月在安庆市立医院肾内科住院并成功行自体 AVF手术的合并有糖尿病的终末期肾病病人的病例资料( n= 135例)根据是否口服阿托伐他汀，分为他汀组(n=63例)和对照组(n=72例)。比较两组病人血脂变化、内瘘功能，探究内瘘失功原因，应，用 Kaplan-Meier分析比较两组内瘘失功情况，采用 Cox回归模型分析阿托伐他汀的应用与内瘘失功的相关性，并比较两组病人的不良事件及预后。结果他汀组术后 6个月总胆固醇、三酰甘油、低密度脂蛋白均低于对照组，差异有统计学意义( P<0.05)；他汀组术后 6个月时内瘘血流量高于对照组，差异有统计学意义( P<0.05)；术后 18个月时内瘘失功率［( 33.3%， 21/63)］低于对照组［(54.2%，39/72)］，差异有统计学意义( P<0.05)；两组失功原因相比较，他汀组内瘘狭窄的比例［( 28.6%，6/ 21)］低于对照组［(56.4%，22/39)］，差异有统计学意义( P<0.05)； Kaplan-Meier生存曲线提示他汀组内瘘失功率低于对照组，差异有统计学意义( P<0.05)；多因素 Cox回归分析显示女性［ HR=2.11，95%CI:(1.14，3.90)P=0.017］为影响 AVF失功的独立危险因素，头静脉内径［ HR=0.18，95%CI:(0.06，0.48)P=0.001］、应用阿托伐他汀［ HR=0.50，9，5%CI:(0.29，0.86)，P=0.011］为影响 AVF失功的保护因素( P<0.05)。他汀组病人脑梗死发，生率［ 3.2%(2/63)］低于对照组［ 13.9%(10/72)］，差异有统计学意义( P<0.05)。结论应用阿托伐他汀能降低合并有糖尿病的终末期肾病病人 AVF失功风险。 |
| 英文摘要: |
| Objective To investigate the effect of atorvastatin on the function of arteriovenous fistula in patients with end-stage re- nal disease complicated with diabetes mellitus.Methods Retrospectively collected case data of patients with end-stage renal diseasecombined with diabetes mellitus who were hospitalized in the Department of Nephrology of Anqing Municipal Hospital and successfullyunderwent autologous AVF surgery from January 2018 to December 2019 (n=135 cases) were divided into the statin group (n=63 cases) and the control group (n=72 cases), according to whether they were taking atorvastatin. Comparing the two groups of patients with bloodlipid changes, exploring the causes of internal fistula failure, applying Kaplan-Meier analysis to compare the internal fistula failure ofthe two groups, analyzing the correlation between the application of atorvastatin and internal fistula failure by using the Cox regressionmodel, and comparing the adverse events and prognosis of the two groups of patients.Results Total cholesterol, triglyceride and low-density lipoprotein levels in the statin group were lower than those in the control group at 6 months postoperatively, and the differenceswere statistically significant (P < 0.05). The internal fistula blood flow in the statin group was higher than that in the control group at 6months postoperatively, and the difference was statistically significant (P < 0.05). Internal fistula power loss at 18 months postoperative-ly [33.3% (21/63)] was lower than that in the control group [54.2% (39/72)], with a statistically significant difference (P < 0.05). Com-paring the causes of loss of power between the two groups, the ratio of internal fistula stenosis in the statin group [28.6% (6/21)] was low-er than that in the control group [56.4% (22/39)], with a statistically significant difference (P < 0.05). The Kaplan-Meier survival curveindicated that the power of internal fistula loss in the statin group was lower than that in the control group, and the difference was statis-tically significant (P < 0.05). Multivariate Cox regression analysis showed that female sex [HR=2.11, 95% CI: (1.14, 3.90), P = 0.017] was independent risk factor affecting AVF loss of function, and cephalic vein internal diameter [HR=0.18, 95% CI: (0.06, 0.48), P=0.001] and the application of atorvastatin [HR=0.50, 95% CI: (0.29, 0.86), P = 0.011] were protective factors affecting AVF loss of func- tion (P < 0.05). The incidence of cerebral infarction in patients in the statin group [3.2% (2/63)] was lower than that in the control group[13.9% (10/72)], and the difference was statistically significant (P < 0.05).Conclusion The application of atorvastatin can reduce the risk of AVF loss of function in patients with end-stage renal disease combined with diabetes mellitus. |
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