不同瘘口直径对维持性血液透析患者自体桡动脉-头静脉内瘘成熟的影响及其预测价值  

Effect and predicative value of fistula diameter on maturation of autogenous radiocephalic arteriovenous fistula in patients with maintenance hemodialysis

作　　者：蔡军军 王旭[1] 黄小抗 施杰[1] 吴国仲[1] 邱海军 Cai Junjun;Wang Xu;Huang Xiaokang;Shi Jie;Wu Guozhong;Qiu Haijun(Department of Renal Vascular Surgery,Anqing Municipal Hospital,Anqing 246001,Anhui,China;Department of Vascular Surgery,Anqing Municipal Hospital,Anqing 246001,Anhui,China)

机构地区：[1]安庆市立医院肾血管外科,安徽安庆246001 [2]安庆市立医院血管外科,安徽安庆246001

出　　处：《血管与腔内血管外科杂志》2022年第8期955-961,共7页Journal of Vascular and Endovascular Surgery

基　　金：安徽医科大学校级科研基金项目(2018xkj077)。

摘　　要：目的探讨不同瘘口直径对维持性血液透析患者自体桡动脉-头静脉内瘘(RCAVF)成熟的影响及其预测价值。方法收集2019年1月至2021年9月安庆市立医院收治的157例终末期肾脏病(ESRD)患者的临床资料,按照瘘口直径的不同将其分为A组(n=54,瘘口直径为6.0~6.9 mm)、B组(n=46,瘘口直径为7.0~7.9 mm)、C组(n=57,瘘口直径为8.0~8.9 mm)。术前采用彩色多普勒超声测量血管内径,术后至少随访2个月。分析瘘口直径与RCAVF成熟的关系,采用Logistic回归模型分析RCAVF成熟的影响因素,采用受试者工作特征(ROC)曲线预测RCAVF成熟的影响因素。结果A、B、C组患者内瘘成熟率分别为64.81%、82.61%和61.40%,内瘘成熟108例,未成熟49例。A、C组患者与B组患者内瘘成熟率比较,差异均有统计学意义(P<0.05)。术后2个月,3组患者头静脉直径、桡动脉流量均较术前增加(P<0.05),A、B组患者桡动脉直径较术前增加(P<0.05);B组患者桡动脉和头静脉直径、桡动脉和头静脉流量均较A、C组增加(P<0.05)。成熟组患者瘘口直径大于未成熟组患者,头静脉扩张性高于未成熟组患者,差异均有统计学意义(P<0.05)。多因素分析结果显示,瘘口直径和头静脉扩张性均是内瘘成熟结局的独立预测因子。ROC曲线显示,瘘口直径为7.585 mm时和头静脉扩张性为0.505 mm时预测RCAVF成熟的曲线下面积(AUC)分别为0.718(95%CI:0.607~0.829)、0.718(95%CI:0.607~0.829),灵敏度分别为93.50%、84.30%,特异度分别为63.30%、89.80%。结论瘘口直径、头静脉扩张性均是RCAVF术后内瘘成熟的重要影响因素,且是RCAVF成熟的独立预测因子,当瘘口直径为7.585 mm、头静脉扩张性为0.505 mm时,对内瘘成熟具有较高的预测灵敏度和特异度。Objective To investigate the effect of fistula diameter of autogenous radiocephalic arteriovenous fistula(RCAVF)on internal fistula maturation in patients with maintenance hemodialysis and its predicative value.Method Clinical data of 157 patients with end-stage renal disease(ESRD)in Anqing Municipal Hospital from January 2019 to September 2021 were collected,and the patients were divided into group A(n=54,fistula diameter of 6.0-6.9 mm),group B(n=46,fistula diameter of 7.0-7.9 mm)and group C(n=57,fistula diameter of 8.0-8.9 mm)according to the diameter of fistula.The preoperative vascular internal diameter was measured by color Doppler ultrasonography and the patients were followed up for at least 2 months.The relationship between fistula diameter and RCAVF maturity was analyzed;Logistic regression analysis was conducted to analyze the risk factors affecting the maturation of RCAVF,and receiver operating characteristic(ROC)curve was used to predict the factors affecting the maturation of fistula.Result The maturation rates of internal fistula in the group A,B,and C were 64.81%,82.61%and 61.40%,respectively,108 mature cases and 49 immature cases.There were significant differences in the internal fistula maturation rate in group A and C with group B(P<0.05).After operation 2 months,the diameter of cephalic vein and radial artery flow in the three groups were increased compared with those before operation(P<0.05),and the diameter of radial artery in group A and B was increased compared with that before operation(P<0.05).The diameter and flow of radial artery and cephalic vein in group B were increased compared with those in group A and C(P<0.05).The diameter of the fistula in the mature group was higher than that in the immature group,and the dilation of the cephalic vein was higher than that in the immature group(P<0.05).Multivariate analysis showed that fistula diameter and cephalic vein dilation were independent predictors of fistula maturation.The ROC curve showed that when the diameter of the fistula was 7.585

关 键 词：维持性血液透析 自体动静脉内瘘 桡动脉 头静脉 瘘口直径 内瘘成熟 

分 类 号：R543[医药卫生—心血管疾病]