标题：自体动静脉内瘘和带隧道涤纶套导管对维持性血液透析患者钙磷代谢、毒素清除率、微炎症状态的影响

      作者：王震霓 1，李双双 2，罗磊 3    1.榆林市星元医院肾病内分泌科，陕西 榆林 719000；2.延安市博爱医院普外科，陕西 延安 716000；3.陕西省核工业二一五医院肾内科，陕西 咸阳 712000

      卷次： 2022年33卷18期

      【摘要】 目的 研究自体动静脉内瘘(AVF)和带隧道涤纶套导管(TCC)对维持性血液透析患者钙磷代谢、毒素清除率、微炎症状态的影响。方法 回顾性分析2018年3月至2021年3月在榆林市星元医院进行维持性血液透析的90例患者的临床资料，根据其血管通路的方式分为TCC组41例和AVF组49例。在透析治疗前与治疗结束后，比较两组患者的钙磷代谢、毒素清除率、微炎症状态和不良反应发生情况。结果 透析治疗后，两组患者的血钙、血磷及甲状旁腺激素(PTH)水平较治疗前降低，且AVF组患者的上述指标水平分别为(1.40±0.29) mmol/L、(1.46±0.20) mmol/L、(7.67±1.61) pmol/L，明显低于TCC组的(1.61±0.30) mmol/L、(1.59±0.37) mmol/L、(8.79±1.86) pmol/L，差异均有统计学意义(P<0.05)；透析治疗前后，两组患者的血肌酐(SCr)、血尿素氮(BUN)、β2微球蛋白(β2-MG)和清除率比较差异均无统计学意义(P>0.05)；透析后，两组患者的肿瘤坏死因子(TNF-α)、白介素-6 (IL-6)、超敏C反应蛋白(hs-CRP)升高，且AVF组的上述指标水平分别为(2.33±0.43) ng/mL、(135.38±12.46) ng/L、(14.04±1.82) ng/L，明显低于TCC组的(2.60±0.51) ng/mL、(148.71±26.31) ng/L、(15.18±2.28) ng/L，差异均有统计学意义(P<0.05)；AVF组患者的不良反应发生率为0.98%，明显低于TCC组的1.72%，差异有统计学意义(P<0.05)。结论 AVF透析治疗的毒素清除率与TCC组相当，但AVF透析治疗更能改善钙磷代谢情况，减轻微炎症状态，降低不良反应发生率。
      【关键词】 自体动静脉内瘘；带隧道涤纶套导管；钙磷代谢；毒素清除率；微炎症状态
      【中图分类号】 R459.5 【文献标识码】 A 【文章编号】 1003—6350（2022）18—2347—04

Effects of autogenous arteriovenous fistula and tunneled cuffed catheter on calcium-phosphorus metabolism,toxin clearance rate, and micro-inflammatory status in patients undergoing maintenance hemodialysis.
WANGZhen-ni 1, LI Shuang-shuang 2, LUO Lei 3. 1. Department of Nephrology and Endocrinology, Xingyuan Hospital of Yulin,Yulin 719000, Shaanxi, CHINA; 2. Department of General Surgery, Bo'ai Hospital of Yan'an City, Yan'an 716000, Shaanxi,CHINA; 3. Department of Nephrology, No.215 Hospital of Shaanxi Nuclear Industry, Xianyang 712000, Shaanxi, CHINA
【Abstract】 Objective To study the effects of autologous arteriovenous fistula (AVF) and tunneled cuffed cathe-ter (TCC) on calcium-phosphorus metabolism, toxin clearance rate, and micro-inflammatory status in patients undergo-ing maintenance hemodialysis. Methods The clinical data of 90 patients undergoing maintenance hemodialysis inXingyuan Hospital of Yulin were retrospectively analyzed between March 2018 and March 2021, and the patients weredivided into TCC group (41 cases) and AVF group (49 cases) according to the vascular access methods. The calci-um-phosphorus metabolism, toxin clearance rate, micro-inflammatory status, and occurrence of adverse reactions werecompared between the two groups before hemodialysis treatment and after hemodialysis. Results After hemodialysis,the levels of blood calcium, blood phosphorus, and parathyroid hormone (PTH) in the two groups were reduced com-pared with those before hemodialysis, and the levels of the above indicators in AVF group were significantly lower thanthose in TCC group: (1.40±0.29) mmol/L, (1.46±0.20) mmol/L, and (7.67±1.61) pmol/L in AVF group versus (1.61±0.30) mmol/L, (1.59±0.37) mmol/L, and (8.79±1.86) pmol/L in TCC group, respectively; the differences were statistical-ly significant (P<0.05). Before and after hemodialysis, there were no statistically significant differences in the levels andclearance rates of serum creatinine (SCr), blood urea nitrogen (BUN), and β 2 microglobulin (β 2-MG) between the twogroups (P>0.05). After hemodialysis, the levels of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and high-sensi-tivity C-reactive protein (hs-CRP) were increased, and the levels of above-mentioned indicators in AVF group were sig-nificantly lower than those in TCC group: (2.33±0.43) ng/mL, (135.38±12.46) ng/L, and (14.04±1.82) ng/L in AVFgroup versus (2.60±0.51) ng/mL, (148.71±26.31) ng/L, and (15.18±2.28) ng/L in TCC group, respectively; the differencewere statistically significant (P<0.05). The incidence rate of adverse reactions in AVF group was significantly lower than