摘要目的 探讨不同血管通路类型对维持性血液透析患者新发心房颤动(atrial fibrillation)的影响及相关危险因素.方法 本研究为前瞻性队列研究.纳入2013年1月1日至2013年6月30日天津医科大学第二医院建立长期透析通路并自愿接受随访的患者,随访5年.依据患者长期通路的类型分为自体动静脉内瘘(内瘘)组和带隧道和涤纶套的颈内静脉导管(导管)组.应用Cox回归分析和受试者工作特征曲线(ROC)评估新发心房颤动的危险因素.结果 共315例符合条件的患者被纳入本研究,男性150例(47.62％),内瘘组189例(60.00％),导管组126例(40.00％).多因素Cox回归分析结果提示年龄增加(HR=1.021,95％CI 1.003～ 1.040)、动静脉内瘘(HR=1.899,95％CI 1.019～ 3.539)、透析血流量增加(HR=1.030,95％CI 1.010～ 1.051)和左房内径增大(HR=1.097,95％CI 1.022～ 1.177)为血液透析患者新发心房颤动的独立危险因素(均P＜ 0.05).Kaplan-Meier生存分析结果提示内瘘组新发心房颤动发生率高于导管组(Log-rank x2=9.53,P=0.002).ROC曲线分析显示年龄[曲线下面积(AUC)为0.608,P=0.008]、动静脉内瘘(AUC为0.594,P=0.021)、透析血流量(AUC为0.659,P＜0.001)、左房内径(AUC为0.604,P=0.011)均可预测心房颤动的发生.结论 年龄增加、动静脉内瘘、透析血流量增加和左房内径增大均是血液透析患者新发心房颤动的独立危险因素,均可预测心房颤动的发生.自体动静脉内瘘患者新发心房颤动率高于导管患者.

abstractsObjective To investigate the effects and related risk factors of different vascular access types on new atrial fibrillation in maintenance hemodialysis (MHD) patients.Methods This was a single-center prospective cohort study.Patients who established long-term dialysis access and were voluntarily followed up in the Second Hospital of Tianjin Medical University from January 1,2013 to June 30,2013 were enrolled to follow-up for 5 years.Patients were divided into fistula group (patients with autogenous arteriovenous fistula) and catheter group (patients with tunneled cuffed internal jugular vein catheter).The incidences of new atrial fibrillation in the two groups were compared by Kaplan-Meier survival analysis.Cox regression analysis and receiver operator characteristic curve (ROC) were used to assess the risk factors of new atrial fibrillation.Results A total of 315 eligible patients were enrolled,including 150 males (47.62％).There were 189 patients (60.00％) in the fistula group,and 126 patients (40.00％) in the catheter group.Multivariate Cox regression analysis showed that older age (HR=1.021,95％CI 1.003-1.040),arteriovenous fistula (HR=1.899,95％CI 1.019-3.539),increased dialysis blood flow (HR=1.030,95％CI 1.010-1.051) and left atrial diameter (HR=1.097,95％CI 1.022-1.177) were independent risk factors for new atrial fibrillation in MHD patients (all P ＜ 0.05).Kaplan-Meier survival analysis showed that the incidence of new atrial fibrillation in fistula group was higher than that in catheter group (Log-rank A2=9.53,P=0.002).ROC curve analysis showed that age [the area under the curve (AUC)=0.608,P=0.008],arteriovenous fistula (AUC=0.594,P=0.021),dialysis blood flow (AUC=0.659,P＜0.001) and left atrial diameter (AUC=0.604,P=0.011) could predict the occurrence of new atrial fibrillation.Condusions Older age,arteriovenous fistula,increased blood flow during dialysis and left atrial diameter are independent risk factors for new atrial fibrillation in MHD patients,which can predict the occurrence of atrial fibrillation.The incidence of new atrial fibrillation in patients with arteriovenous fistula is higher than that in patients with catheter.