维持性血液透析患者自体动静脉内瘘失功危险因素模型构建及防治策略  

Construction of risk factors for autologous arteriovenous fistula failure in 120 patients with chronic kidney disease stage 4 to 5 maintenance hemodialysis and prevention strategies

作　　者：杨克 罗来月 柳亿 Yang Ke;Luo Laiyue;Liu Yi(Department of Nephrology,Anji Branch of the First Affiliated Hospital of Zhejiang University(Anji County People′s Hospital),Huzhou 313300,China)

机构地区：[1]浙江大学附属第一医院安吉分院(安吉县人民医院)肾内科,湖州313300

出　　处：《中国医师进修杂志》2023年第5期444-448,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的分析维持性血液透析(MHD)患者自体动静脉内瘘失功危险因素,并构建回归模型,对模型预测价值进行分析进而提出防治策略。方法回顾性分析2020年1月至2022年2月安吉县人民医院接受MHD治疗的120例患者的相关资料,根据患者是否发生自体动静脉内瘘失功将其分为失功组(25例)和通畅组(95例)。比较两组基线资料,并采用多因素Logistic回归分析法分析MHD患者自体动静脉内瘘失功的危险因素,通过建立回归模型研究其预测价值。结果失功组女性、合并糖尿病、临时置管透析的患者占比均高于通畅组[56.00%(14/25)比33.68%(32/95)、44.00%(11/25)比13.68%(13/95)、92.00%(23/25)比65.26%(62/95)];置管时间、血浆甲状腺旁激素、血清白蛋白、D-二聚体、纤维蛋白原及血磷水平高于通畅组[(47.87±18.43)d比(39.65±16.58)d、(439.76±23.45)ng/L比(354.54±31.26)ng/L、(43.43±2.54)g/L比(39.65±2.31)g/L、(1.13±0.32)mg/L比(0.23±0.07)mg/L、(5.64±2.14)g/L比(2.76±0.76)g/L、(3.54±1.02)mmol/L比(0.76±0.05)mmol/L](P<0.05)。多因素Logistic回归分析结果显示,女性、合并糖尿病、临时置管透析、血磷水平高是MHD患者自体动静脉内瘘失功的独立危险因素(OR=2.654、3.077、3.721、2.646,P<0.05)。回归方程模型:logit(P)=-12.763+性别×0.976+糖尿病×1.124+临时置管透析×1.314+血磷水平×0.973,当Logistic(P)>18.542时,模型预测自体动静脉内瘘失功发生曲线下面积为0.882,95%CI 0.811~0.934,灵敏度为80.00%,特异度为83.16%。结论女性、合并糖尿病、临时置管透析、血磷水平高是MHD患者自体动静脉内瘘失功的独立危险因素,该模型对MHD患者自体动静脉内瘘失功发生具有较好预测价值,临床可针对伴有以上情况的患者采取相应的治疗及干预措施,以降低自体动静脉内瘘失功发生的风险,提高治疗效果。Objective To explore the risk factors and prevention strategies for autologous arteriovenous fistula failure in 120 maintenance hemodialysis(MHD)patients,and build a regression model.Methods The clinical data of 120 patients received MHD treatment in Anji County People′s Hospital from January 2020 to February 2022 were retrospectively analyzed,and the selected patients were divided into the failure group(25 cases)and the patency group(95 cases)according to whether they had autologous arteriovenous fistula failure.The clinical data of the two groups were compared.Multivariate Logistic regression analysis method was used to analyze the risk factors of autologous arteriovenous fistula failure in MHD patients.And a Logistic regression model was established to analyze the predictive value.Results The proportions of women,diabetes and temporary catheter dialysis patients in the failure group were higher than those in the patency group:56.00%(14/25)vs.33.68%(32/95),44.00%(11/25)vs.13.68%(13/95),92.00%(23/25)vs.65.26%(62/95);the time of catheterization,plasma parathyroid hormone,serum albumin(Alb),D-Dimer(D-D),fibrinogen(FIB)and phosphorus were higher than those in the patency group:(47.87±18.43)d vs.(39.65±16.58)d,(439.76±23.45)ng/L vs.(354.54±31.26)ng/L,(43.43±2.54)g/L vs.(39.65±2.31)g/L,(1.13±0.32)mg/L vs.(0.23±0.07)mg/L,(5.64±2.14)g/L vs.(2.76±0.76)g/L,(3.54±1.02)mmol/L vs.(0.76±0.05)mmol/L(P<0.05).The results of multivariate Logistic regression analysis showed that female,concomitant diabetes,temporary catheter dialysis,and high level of serum phosphorus were independent risk factors for autologous arteriovenous fistula failure in MHD patients(OR=2.654,3.077,3.721,2.646;P<0.05).Regression equation model was:logit(P)=-12.763+sex×0.976+diabetes×1.124+temporary catheter dialysis×1.314+level of blood phosphorus×0.973.When Logistic(P)>18.542,the area under the curve(AUC)value for autologous arteriovenous fistula failure prediction in this model was 0.882(95%CI from 0.811 to 0.934),and with sensitivity o

关 键 词：血液透析滤过 自体动静脉内瘘失功 危险因素 预测价值 

分 类 号：R692.5[医药卫生—泌尿科学]