| 郑寿浩,丁国明,吴鑫洪,王黉,项燕妮,韩颖敏.动静脉内瘘血流量对慢性血液透析患者心功能及血清Cystatin C、Hcy、BNP水平的影响[J].浙江中西医结合杂志,2020,30(2): |
| 动静脉内瘘血流量对慢性血液透析患者心功能及血清Cystatin C、Hcy、BNP水平的影响 |
| Effects of Blood Flow in Arteriovenous Fistula on Cardiac Function and Serum Levels of Cystatin C, Hcy and BNP in Patients with Chronic Hemodialysis |
| 投稿时间：2019-06-26 修订日期：2019-12-30 |
| DOI： |
| 中文关键词: 动静脉内瘘 血液透析 Cystatin C、Hcy、BNP 心功能 |
| 英文关键词:Arteriovenous fistula Hemodialysis Chronic renal failure Cardiac function |
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| 中文摘要: |
| 目的 探讨动静脉内瘘血流量对慢性血液透析患者心功能及血清Cystatin C、Hcy、BNP水平的影响。方法 选取2015年4月至2018年3月在我院采用动静脉内瘘行血液透析治疗的80例慢性肾功能衰竭患者，根据动静脉内瘘血流量（AVFB）水平分为低流量组（<400 ml /min）；中流量组（400 ml /min -600 ml /min）；高流量组（>600 ml /min）。术后1个月开始使用内瘘时和1年后行超声心动图检测心功能指标，同时检测血清Cystatin C、Hcy、BNP水平，并分析AVFB与其之间的关系。结果 透析前三组患者的CO、CI、EF、LAD、LVDd、LVDs、E、A和E/A均无明显差异（均P>0.05）；透析1年后高流量组患者的CO、CI、EF、LAD、LVDd、LVDs和E/A明显高于低流量组和中流量组，差异具有统计学意义（均P<0.05），而中流量组与低流量组患者心功能指标互相比较均无统计学差异（均P>0.05）；透析1年后高流量组及中流量组患者的CI、EF、LAD明显高于透析前，差异具有统计学意义（均P<0.05），其CO、LVDd、E、A和E/A也明显高于透析前，差异具有统计学意义（均P<0.01）；透析1年后高流量组的LVDs 高于透析前（P<0.05）。透析前三组患者的血清的Cystatin C、Hcy、BNP均无明显差异（均P>0.05）；透析1年后高流量组患者的Cystatin C、Hcy、BNP明显高于低流量组和中流量组，差异具有统计学意义（均P<0.05），而中流量组与低流量组患者的Cystatin C、Hcy、BNP指标互相比较均无统计学差异；透析1年后高流量组和中流量组患者的Cystatin C明显高于透析前，差异具有统计学意义（P<0.01），而Hcy水平明显低于透析前，差异具有统计学意义（P<0.01）。AVFB 与Cystatin C呈正相关(r=0.648，P＜0.05)，与Hcy、BNP呈负相关（r=0.542、0.147，P＜0.05）。结论 AVFB与心功能密切相关，AVF的通畅可以减弱心功能的影响；AVFB与Cystatin C呈正相关，与Hcy、BNP呈负相关。 |
| 英文摘要: |
| Objective To investigate the effects of blood flow in arteriovenous fistula on cardiac function and serum levels of Cystatin C, Hcy and BNP in patients with chronic hemodialysis. Methods 80 patients with chronic renal failure underwent hemodialysis with arteriovenous fistula in our hospital from April 2015 to March 2018 were enrolled, and were divided into three groups according to arteriovenous fistula blood flow (AVFB), namely, low-flow group (<400 ml /min), medium flow group (400 ml /min -600 ml /min) and high flow group (>600 ml /min). Then the cardiac function indicators detected by echocardiography at 1 month after operation and 1 year after operation, and serum Cystatin C, Hcy, BNP levels were recorded, and their relationship with AVFB was determined. Results There were no significant differences in CO, CI, EF, LAD, LVDd, LVDs, E, A and E/A among the three groups before dialysis (all P>0.05). The CO, CI, EF, LAD, LVDd, LVDs and E/A in the high flow group were significantly higher than those in the low flow group and the medium flow group one year after dialysis (all P<0.05), but there was no significant difference in the cardiac function index between the low flow group and the low flow group (all P<0.05). After 1 year of dialysis, the CI, EF and LAD of high flow group and medium flow group were significantly higher than those before dialysis (all P<0.05), and the CO, LVDd, E, A and E/A of high flow group were also significantly higher than those before dialysis (all P<0.01). After 1 year of dialysis, the LVDs of high flow group was higher than that before dialysis (P<0.05). There was no significant difference in serum Cystatin C, Hcy and BNP among the three groups before dialysis (all P>0.05). After 1 year of dialysis, the levels of Cystatin C, Hcy and BNP in the high flow group were significantly higher than those in the low flow group and the medium flow group (all P<0.05), while there was no significant difference in the indicators of Cystatin C, Hcy and BNP between the middle flow group and the low flow group. Cystatin C in the high flow group and middle flow group was significantly higher than that before dialysis (P<0.01), while Hcy level was significantly lower than that before dialysis (P<0.01). AVFB was positively correlated with Systeatin C (r=0.648, P<0.05), negatively correlated with Hcy and BNP (r=0.542, 0.147, P<0.05). Conclusion AVFB is closely related to cardiac function, the patency of AVF can weaken cardiac function, moreover, AVFB is positively correlated with Systin C, negatively correlated with Hcy and BNP. |
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