终末期肾病患者血清晚期糖基化终末产物水平是首次动静脉内 瘘术后狭窄的危险因素

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Elevated advanced glycation endproducts is a risk factor for stenosis after primary arteriovenous fistula surgery

LI Tianhong1²，QINXinfang，WEILili，BIHuin2

Deprtetdll

AffiliatedHospitalofouthernedicalniversity，Guangzhou5o999，ina

Abstract：Objective Toinvestigate theefect of serumadvancedglycationendproducts （AGEs）on stenosisafter first autologousarteriovenousfistula （AVF）inpatientswithend-stagerenal disease （ESRD）.MethodsPatientswithESRD undergoingstandardnativearteriovenousstula（AVF）forthistieinteDeparmentofNphrologyAfilatedHospital of GuilinMedicalUniversity fromFebruary to June 202 were prospectively enrolled.The preoperative general data，clinical examinationresultsandultrasounddataof theoperatedlimbswerecolected.Thepatientswithandwithoutstenosis within2 months after the operation werecompared for preoperative serum AGEs levels detected using ELISA and the clinical parameters.Logisticregresionanalysiswasused toanalyzetheindependentriskfactorsof AVFstenosis，andthesensitivity and specificityof AGEs for predicting postoperative stenosis were analyzed using receiver-operating characteristic （ROC） curve.ResultsOfthe94patientsenrolled，34hadpostoperativearteriovenousstenosisand60adnostenosis.Theuberof diabetic patients differed significantly between stenosis group and non-stenosis group （P<0.001） . SerumAGEs levels，which werenegativelycorrelatedwith serum phosphoruslevel （P<0.05） ，weresignificantly higherin stenosis group than in nonstenosis group （Z=-2.837， P=0.005 ）. Serum AGE level wasan independent risk factor for postoperative stenosisafter AVF （OR 1.251， 95% CI：1.096-1.423， P<0.001 ）.For predictingAVFstenosis，theareaunder the ROC curve （AUC） ofAGEswas0.677（ P= 0.007， 95% CI： 0.572-0.770），with a specificity of 90.00% and a sensitivity of 52.94% at the optimal cut-off value of 8.43μg/mL; AGEscombinedwith fibrinogen hadanAUCof 0.763 95% CI： 0.664-0.844），with a specificity of 73.33% and a sensitivity of 70.59% at theoptimal cut-off value of O.30.Conclusions Elevated serum AGEs level isan independent risk factor for postoperative AVFstenosis，and itscombination with fibrinogen hasabeter eficacyfor predicting postoperative AVF stenosis.

Keywords： advanced glycation end products; arteriovenous fistula stenosis; end-stage renal disease;fibrinogen

肾脏替代治疗是终末期肾病（ESRD）患者的主要治疗方法，包括血液透析（HD）腹膜透析（PD）及肾移植，透析治疗现已成为患者维持生命的主要治疗方法，其中，维持性血液透析（MHD）最为常用，占全部透析治疗的 90% 左右。（剩余19267字）