PTA球囊扩张压力对动静脉内瘘狭窄PTA术后通畅率的影响及其危险因素分析  

Influence of balloon dilatation pressure of percutaneous transluminal angioplasty(PTA)on the patency rate of arteriovenous fistula after PTA and the risk factors analysis

作　　者：迟雁青[1] 李闫 郭藏卉 王保兴[1] Chi Yan-Qing;Li Yan;Guo Cang-Hui;Wang Bao-Xing(Kidney Disease Research Center of Hebei Province/Department of Nephrology,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院肾内科/河北省肾脏病研究中心,石家庄050051

出　　处：《解放军医学杂志》2021年第11期1085-1091,共7页Medical Journal of Chinese People's Liberation Army

基　　金：河北省重点研发计划项目(20377753D)。

摘　　要：目的探讨经皮腔内血管成形术(PTA)球囊最大扩张压力对动静脉内瘘狭窄PTA术后12个月内通畅率的影响,筛选影响PTA术后再狭窄的独立危险因素。方法纳入2019年1-12月于河北医科大学第三医院肾内科成功行PTA的100例患者,收集其基本数据、基础病史、合并症、相关血清学指标及内瘘狭窄类型,并通过门诊复诊或电话随访PTA术后12个月的内瘘通畅情况。根据患者术中扩开狭窄处所需的最大压力,将患者分为高压组(扩开狭窄处所需最大球囊压力≥20 atm)与低压组(扩开狭窄处所需最大球囊压力<20 atm),比较两组患者的基本数据、基础病史、合并症、相关血清学指标及术后通畅率;采用Cox比例风险模型分析PTA术后内瘘再狭窄的危险因素;采用ROC曲线评价最大球囊扩张压力对术后12个月内再狭窄的预测价值。结果100例患者中,男48例,女52例,年龄(53.21±15.75)岁,PTA时中位透析龄为24.0(12.0,49.5)个月,中位内瘘时长12.6(5.1,37.4)个月。所有患者均完成随访。高压组患者原发病为糖尿病肾脏疾病的比例、合并高血压的比例及PTA术后12个月再狭窄率高于低压组,差异有统计学意义(P<0.05)。低压组患者术后12个月的通畅率高于高压组(Log-rank检验,χ^(2)=5.399,P=0.020)。Cox多因素生存分析结果显示,扩开狭窄处所需的最大扩张压力和低血镁是PTA术后再狭窄的独立危险因素(P<0.05)。ROC曲线分析结果显示,最大球囊扩张压力的曲线下面积(AUC)=0.619(95%CI 0.496~0.742,P<0.05),具有诊断价值,其最大球囊扩张压力临界值为19 atm,敏感度为60.5%,特异度为66.1%。结论PTA术中所需扩张压力高的患者术后12个月内更易发生再狭窄。影响PTA术后再狭窄的独立危险因素包括PTA术中所需最大扩张压力和高血镁。Objective To explore the effect of the maximum dilatation pressure of percutaneous transluminal angioplasty(PTA)balloon on the patency rate of arteriovenous fistula stenosis within 12 months after PTA,and screen out the independent risk factors that affect restenosis after PTA.Methods A hundred patients,admitted and successfully undergone PTA in the Department of Nephrology,the Third Hospital of Hebei Medical University during January to December 2019,were recruited as the subjects,and of them the basic information,primary medical history,comorbidities,related serological indicators and types of fistula stenosis were collected.The internal fistula patency of patients for 12 months after PTA surgery was traced and collected through outpatient or telephone follow-up.According to the maximum pressure required to expand the stenosis during the operation,the patients were divided into high-pressure group(the maximum balloon pressure required to expand the stenosis≥20 atm)and low-pressure group(the maximum balloon pressure required to expand the stenosis<20 atm),The basic information,primary medical history,comorbidities,related serological indicators and postoperative patency rate were compared between the two groups,and the risk factors leading to restenosis of internal fistula after PTA were analyzed by COX survival analysis.The receiver operating characteristic(ROC)curve was employed to evaluate the predictive value of the maximum balloon inflation pressure for restenosis within 12 months after PTA.Results A total of 100 patients were enrolled in present study,including 48 males and 52 females with average age of(53.21±15.75)years,the median dialysis age at PTA of 24.0(12.0,49.5)months,and the median duration of fistula of 12.6(5.1,37.4)months.All patients were completely followed up.The rates of diabetic kidney disease in primary diseases,hypertension and the restenosis rate within 12 months after PTA were higher in high-pressure group than those in low-pressure group with statistically significance(P<0.05).The

关 键 词：经皮腔内血管成形术 动静脉内瘘 球囊压力 通畅率 再狭窄 

分 类 号：R57[医药卫生—消化系统]