自体动静脉内瘘成熟的预测因素及辅助成熟干预时机的初步探讨  

Predictive factors of autogenous arteriovenous fistula maturation and preliminary study on assisted maturation intervention timing

作　　者：赵彬 王慧 王玉柱[1] 张丽红[1] 马文录[2] 詹申 Zhao Bin;Wang Hui;Wang Yuzhu;Zhang Lihong;Ma Wenlu;Zhan Shen(Department of Nephrology,Haidian Hospital,the Third Hospital of Peking University,Beijing 100080,China;Department of Nephrology,Sinopharm North Hospital,Baotou 014030,China)

机构地区：[1]北京大学第三医院海淀院区(北京市海淀医院)肾内科,北京100080 [2]国药北方医院肾内科,包头014030

出　　处：《中华肾脏病杂志》2023年第4期263-271,共9页Chinese Journal of Nephrology

基　　金：2022年北京大学第三医院海淀院区(北京市海淀医院)院级基金项目(KYQ2022001)。

摘　　要：目的分析自体动静脉内瘘(arteriovenous fistula,AVF)成熟的预测因素,初步探讨辅助成熟的干预时机。方法该研究为回顾性研究,分析2018年8月1日至2022年3月31日在北京大学第三医院海淀院区新建立AVF并规律随访的患者资料。根据AVF建立后3个月是否达到临床成熟或超声成熟标准,将患者分为成熟组和非成熟组,比较两组一般情况、术前实验室检查及术后超声检查参数等资料。采用Logistic回归分析模型分析AVF成熟的相关因素,并绘制受试者工作特征曲线,探讨各相关因素对AVF成熟的预测效能及干预时机。结果纳入研究对象共568例,年龄(56.86±13.82)岁,男性339例(59.68%),女性229例(40.32%)。其中成熟组380例,非成熟组188例。研究对象的总体AVF成熟率为66.90%(380/568)。成熟组术后1个月吻合口内径(t=9.732,P<0.001)、ln(1个月吻合动脉内径)(t=10.116,P<0.001)、1个月吻合静脉内径(t=13.961,P<0.001)、ln(1个月肱动脉内径)(t=9.362,P<0.001)、1个月肱动脉血流量(t=16.542,P<0.001)、3个月吻合口内径(t=7.356,P<0.001)、3个月吻合动脉内径(t=11.117,P<0.001)、3个月吻合静脉内径(t=12.332,P<0.001)、ln(3个月肱动脉内径)(t=7.956,P<0.001)及3个月肱动脉血流量(t=13.803,P<0.001)均显著高于非成熟组。Logistic回归分析结果显示术后1个月吻合静脉内径(OR=0.577,95%CI 0.342~0.975,P=0.040)、术后1个月肱动脉血流量(OR=0.988,95%CI 0.996~1.000,P=0.043)及术后3个月肱动脉血流量(OR=0.997,95%CI 0.995~0.999,P=0.002)是AVF无辅助成熟的独立相关因素。受试者工作特征曲线分析结果显示,患者AVF术后1个月吻合静脉内径≥3.90 mm(AUC=0.842,95%CI 0.809~0.871,P<0.001),1个月肱动脉血流量≥446.90 ml/min(AUC=0.880,95%CI 0.850~0.906,P<0.001),或者拟合术后1个月吻合静脉内径和1个月肱动脉血流量的联合指标的临界值≥0.44(AUC=0.889,95%CI 0.860~0.914,P<0.001),以及3个月肱动脉血流量≥595.00 ml/min(AUC=0.857,95%CI 0Objective To analyze the predictive factors of autogenous arteriovenous fistula(AVF)maturation and tentatively discuss the intervention timing of assisted maturation.Methods It was a retrospective study.The data of patients with newly established AVF and regular follow-up in Haidian Hospital,the Third Hospital of Peking University from August 1,2018 to March 31,2022 were analyzed.The patients were divided into mature group and immature group based on whether they met clinical maturity or ultrasonic maturity criteria 3 months after AVF establishment.The general data,preoperative laboratory examination and postoperative ultrasonic examination parameters were compared between the two groups.Logistic regression analysis model was used to analyze the related factors of AVF maturation,and receiver operating characteristic curve(ROC curve)was drawn to evaluate the predictive value of each factor for AVF maturation and intervention timing.Results A total of 568 patients were included,with age of(56.86±13.82)years old,339 males(59.68%),and 229 females(40.32%).There were 380 patients in the maturation group and 188 patients in the immature group.The total rate of AVF maturation was 66.90%(380/568).The anastomosis diameter(t=9.732,P<0.001),ln(anastomosis artery diameter)(t=10.116,P<0.001),anastomosis vein diameter(t=13.961,P<0.001),ln(brachial artery diameter)(t=9.362,P<0.001)and brachial artery blood flow(t=16.542,P<0.001)of postoperation one month,and anastomosis diameter(t=7.356,P<0.001),anastomosis artery diameter(t=11.117,P<0.001),anastomosis vein diameter(t=12.332,P<0.001),ln(brachial artery diameter)(t=7.956,P<0.001)and brachial artery blood flow(t=13.803,P<0.001)of postoperation three months in the mature group were significantly higher than those in the immature group.Logistic regression analysis models showed anastomosis vein diameter at 1 month after surgery(OR=0.577,95%CI 0.342-0.975,P=0.040),brachial arterial blood flow at 1 month after surgery(OR=0.988,95%CI 0.996-1.000,P=0.043)and brachial arterial blood flo

关 键 词：动静脉瘘 危险因素 早期医疗干预 辅助成熟 

分 类 号：R692.5[医药卫生—泌尿科学]