预测自体动静脉内瘘成熟的列线图模型的建立  

A nomogram to predict the maturity of arteriovenous fistulas for hemodialysis

作　　者：梁玉枫[1] 陈勇平[1] 涂淑珍[2] 邱莉 廖伟增[3] 黄彬三 丘美兰 卢彩成 LIANG Yu-feng;CHEN Yong-ping;TU Shu-zhen;QIU Li;LIAO Wei-zeng;HUANG Bin-san;QIU Mei-lan;LU Cai-chen(Department of Nephrology and 3Ultrasonography Section,The Second Hospital of Longyan,Fujian 364000,China;Department of Mathematics and Applied Mathematics,Longyan University,Fujian 364000,China)

机构地区：[1]龙岩市第二医院肾内科,福建364000 [2]龙岩学院数学与应用数学系,福建364000 [3]龙岩市第二医院彩超室,福建364000

出　　处：《中国血液净化》2019年第2期110-114,共5页Chinese Journal of Blood Purification

基　　金：龙岩市科技计划项目(2016LY65);福建省卫生计生委青年项目(2017-01-97);福建省中青年教师科研项目(ja15487)

摘　　要：目的通过对行自体动静脉内瘘(arteriovenous fistulas,AVF)的尿毒症患者术前临床资料、彩超检查等指标构建列线图模型,探讨预测AVF成熟度的方法。方法选取2016年1月～2018年1月收治的238例确诊终末期肾病并且需要行AVF手术的患者组成建模组,收集2018年1月1日～2018年8月1日拟行AVF的尿毒症患者80例,作为验证组。收集患者相关指标,经单因素筛选临床变量后,应用Logistic回归模型进行多因素分析,确立进入最终模型变量。采用R 3.4.3统计软件建立列线图,引入最终进入多因素模型的所有变量,进一步评估模型的效能。结果 238例尿毒症患者,动静脉内瘘成熟发生率为74.8%,收缩压(OR=0.987,95%CI:0.975～0.999,P=0.032),血磷(OR=0.012,95%CI:0.312～0.866,P=0.012),总胆固醇(OR=0.694,95%CI:0.577～0.835,P=<0.001),合并糖尿病(OR=0.226,95%CI:0.107～0.477,P=<0.001),合并高血压(OR=0.121,95%CI:0.059～0.249,P=<0.001)为影响AVF成熟的危险因素,而头静脉内径(OR=7.301,95%CI:3.369～15.821,P=<0.001)、桡动脉内径(OR=3.225,95%CI=1.441～7.218,P=0.004)、桡动脉流速(OR=1.086,95%CI:1.058～1.115,P<0.001)、加压后静脉内径(OR=2.955,95%CI:1.747～4.998,<0.001)为影响AVF成功率的保护性因素。根据多因素分析结果,由头静脉内径(β=1.700,P<0.001)、桡动脉流速(β=0.054,P<0.001)、总胆固醇(β=-0.326,P=0.034)、合并高血压(β=-1.549,P=0.002)、合并糖尿病(β=-1.183,P=0.017)建立的列线图模型进行内部预测,通过bootstrap法进行内部验证,模型的校正情况良好,AVF成熟的发生率c-index为0.897。校准曲线显示列线图预测与实际观察的AVF成熟发生率有良好的一致性。受试者工作曲线(ROC曲线)分析显示验证组80例运用列线图预测AVF成熟的效能AUC为0.848(95%CI:0.745～0.952,P<0.001),其诊断价值高于传统徒手检查(AUC 0.649,95%CI:0.540～0.758,P=0.028)、术前彩超筛查(AUC 0.786,95%CI:0.694～0.879,P<0.001)。结论本研究构建的列线�Objective To develop a nomogram for predicting arteriovenous fistula(AVF)maturity in hemodialysis patients.Methods A total of 238 hemodialysis patients treated in the period from January 1,2016 to January 1,2018 were enrolled in this study as the model group,and a total of 80 uremic patients treated in the period from January 1,2018 to July 8,2018 were recruited as the validation group.Baseline characteristics and ultrasound parameters were collected for analyses.We performed logistic regression analysis to identify the independent risk factors for AVF maturity,and then constructed a nomogram according to a regression equation to predict the results.Concordance index(C-index)and calibration curve were used to verify the predictive and discriminative abilities of the nomogram.Results A total of 176 patients(74.8%)achieved AVF maturation during the 8-week study period.Multivariate logistic regression showed that the risk factors for AVF maturity included systolic pressure(OR=0.987,95%CI:0.975~0.999,P=0.032),serum phosphate(OR=0.012,95%CI:0.312~0.866,P=0.012),serum cholesterol(OR=0.694,95%CI:0.577~0.835,P<0.001),diabetes(OR=0.226,95%CI:0.107~0.477,P<0.001)and hypertension(OR=0.121,95%CI:0.059~0.249,P<0.001);and that the protective factors significantly associated with the maturity included cephalic vein diameter(OR=7.301,95%CI:3.369~15.821,P<0.001),radial artery diameter(OR=3.225,95%CI=1.441~7.218,P=0.004),radial artery blood flow(OR=1.086,95%CI:1.058~1.115,P<0.001)and cephalic vein diameter after pressure(OR=2.955,95%CI:1.747~4.998,P<0.001).A nomogram,which included the variances of cephalic vein diameter(β=1.700,P<0.001),radial artery blood flow(β=0.054,P<0.001),serum cholesterol(β=-0.326,P=0.034),diabetes(β=-1.183,P=0.017)and hypertension(β=-1.624,P=0.002),was constructed.This nomogram has better discrimination and calibration abilities to predict AVF maturation.Receiver operator curves(ROC)indicated that the area under the curve(AUC)of the nomogram model was higher than that of physical and routine color Do

关 键 词：尿毒症 动静脉内瘘 成熟 列线图 

分 类 号：R318.16[医药卫生—生物医学工程]