内瘘静脉最小内径可作为判断自体动静脉内瘘狭窄的指标  

Minimal diameter of the fistula vein defines a significant stenosis in an autologous arteriovenous fistula

作　　者：徐元恺[1] 甄景琴[2] 张文云[2] 段青青[1] 张丽红[1] 

机构地区：[1]河北医科大学第三医院肾内科,石家庄050051 [2]河北医科大学第三医院超声科,石家庄050051

出　　处：《中华肾脏病杂志》2017年第3期187-190,共4页Chinese Journal of Nephrology

基　　金：河北省科技惠民计划项目（15277743D）

摘　　要：目的探索适合中国人自体动静脉内瘘狭窄的界定及影响内瘘功能的静脉内径数值。方法回顾性分析河北医科大学第三医院肾内科因自体动静脉内瘘丧失功能而接受内瘘修复手术患者的内瘘相关血管的超声检查结果（研究组），以本中心正常使用的前臂自体动静脉内瘘患者作为对照组，用受试者工作特征（ROC）曲线分析以内瘘静脉最小内径作为判断自体动静脉内瘘狭窄的特异性、敏感性和诊断正确度，并得出可行的截断值。结果42例研究组患者平均年龄（54．63±2．44）岁，平均透析龄（43．29±2．44）个月，平均内瘘丧失功能时间7．00（6．25，14．25）d。68例对照组患者平均年龄（52．56_＋2．00）岁，平均透析龄27（14，53）个月，平均内瘘使用时间20．0（11．5，41．0）个月。研究组患者平均内瘘静脉最小内径（1．57±0．07）mm，前臂内瘘静脉内径（4．04_＋0．23）mm；对照组患者内瘘静脉最小内径（3．34±0．11）mm，前臂内瘘静脉内径5．36（4．52，6．45）mm，两组间比较差异有统计学意义（均Pc0．05）。以内瘘静脉最小内径作为判断前臂自体动静脉内瘘狭窄的判断标准具有较高的检出率，ROC曲线下面积0．979，95％CI为0．959～0．998。当截断值取2．40mm时，曲线下面积最大（0．853）。结论自体动静脉内瘘丧失功能患者的内瘘静脉内径最小值明显小于内瘘正常使用的患者，静脉最小内径绝对值可作为判断前臂自体动静脉内瘘狭窄的指标之一。Objective To define a parameter of autologous arteriovenous fistula stenosis that limits the fistula function for hemodialysis in our country. Methods Retrospectively study the doppler ultrasound of patients who accepted the percutaneous transluminal angioplasty （PTA） therapy due to autogenous arteriovenous fistula dysfunction; identify the least diameter of the fistula vein and compare it with the corresponding data of well-functioned fistula. Determine which absolute diameter constitutes a hemodynamically significant stenosis in a radiocephalic autologous arteriovenous fistula by receiver operating characteristic curve （ROC curve）. Result Forty-two patients were enrolled in the study. The average age of those patients was 54.63±2.44 years old. Twenty- one patients were female. Twenty- six fistula located on the left arm. The minimal diameter of the dysfunction fistula averaged 1.57±0.07 ram, while the average forearm fistula vein diameter was 4.04±0.23 mm, significantly smaller than those in the compare group - an average minimal fistula vein diameter of 3.34±0.11 mm and a forearm vein diameter of 5.36（4.52, 6.45） mm （P 〈 0.05）. The control group contained sixty- eight patients. The average age of those patients was 52.56±2.00 years old. Thirty-one patients were female. Forty- nine fistula located on the left arm. It was quiet appropriate in using minimal diameter of the fistula vein to indicate the dysfunction istula with an under-curve area of 0.979, 95%CI 0.959-0.998. The under-curve area would be at the largest level when meeting the cutoff point at 2.40mm, in which it could achieve the area of 0.853. Conclusions The minimal diameter of the dysfunction wrist autogenous arteriovenous fistula was much smaller than the functioned ones. Minimal diameter of the fistula vein may serve as an effective parameter in detecting dysfunction fistula.

关 键 词：动静脉瘘 缩窄 病理性 截断值 

分 类 号：R459.5[医药卫生—治疗学]