多普勒超声指导下尿激酶治疗急性动静脉内瘘血栓无效因素的Logistic回归分析  

Logistic Regression Analysis of the Ineffectiveness of Urokinase in the Treatment of Acute Arteriovenous Fistula Thrombosis Under the Guidance of Doppler Ultrasound

作　　者：高良云 朱星瑜 王悦琳 胡日红[2] 姚国明[2] GAO Liangyun;ZHU Xingyu;WANG Yueling(Department of Nephrology,Hangzhou Hospital of Traditional Chinese Medicine,Zhejiang Chinese Medical University,Hangzhou,310007;不详)

机构地区：[1]杭州市中医院肾内科,杭州310007 [2]杭州市丁桥医院(杭州市中医院丁桥院区)肾内科,杭州310021

出　　处：《中国中西医结合肾病杂志》2023年第9期795-799,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：浙江省基础公益研究计划项目(No.LGF21H050002);杭州市医学重点学科建设项目。

摘　　要：目的:采用Logistic回归分析探讨多普勒超声指导下尿激酶治疗维持性血液透析患者急性动静脉内瘘血栓无效的影响因素。方法:回顾性研究2017年01月—2021年08月杭州市中医院肾内科收治的急性动静脉内瘘血栓患者95例(AVF60例、AVG 35例),收集一般资料、溶栓并发症、内瘘查体及超声结果。以内瘘是否溶栓无效为二分类因变量,运用非条件Logistic回归分析方法探讨内瘘溶栓无效的影响因素。结果:Logistic回归分析显示:栓塞时间较长(OR=1.074,95%CI:1.009~1.143)、血栓长度较长(OR=1.099,95%CI:1.020~1.184)、吻合口内径较小(OR=0.416,95%CI:0.193~0.895)、吻合口流速较低(OR=0.981,95%CI:0.966~0.997)是AVF溶栓无效的危险因素;栓塞时间较长(OR=1.140,95%CI:1.004~1.296)、肱动脉吻合口搏动较弱(OR=0.358,95%CI:0.129~0.996)、贵要静脉血栓较长(OR=1.961,95%CI:0.963~3.991)是AVG溶栓无效的危险因素。ROC曲线提示预测AVF溶栓无效的相关因素中栓塞时间、血栓长度、吻合口内径、吻合口流速的最佳临界点分别为11.5 h、66 mm、4.3 mm、52.3 cm/s;预测AVG溶栓无效的相关因素中栓塞时间、贵要静脉血栓长度的最佳临界点分别为22.5 h、3.5 mm。结论:透析患者急性动静脉内瘘血栓形成后,不能盲目进行溶栓治疗,以免增加内瘘血管二次损伤、消耗有限的血管资源。内瘘栓塞时间、吻合口内径、血栓长度、动脉吻合口血流速、肱动脉吻合口搏动强度可作为尿激酶溶栓治疗参考指标之一,为临床预后判断提供依据,提高溶栓的有效率。Objective:Logistic regression analysis was used to explore the influencing factors of ineffective urokinase in the treatment of acute arteriovenous fistula thrombosis in maintenance hemodialysis patients.Methods:A retrospective study was conducted on 95 patients with acute arteriovenous fistula thrombosis(60 AVF patients and 35 AVG patients)admitted to the Department of Nephrology,Hangzhou Hospital of Traditional Chinese Medicine from January 2017 to August 2021.body and ultrasound results.Whether the internal fistula was ineffective in thrombolysis was a dichotomous dependent variable,and the unconditional Logistic regression analysis method was used to explore the influencing factors of the ineffective thrombolysis in internal fistula.Results:Logistic regression analysis showed that the embolization time was longer(OR=1.074,95%CI:1.009~1.143),the thrombus length was longer(OR=1.099,95%CI:1.020~1.184),and the inner diameter of the anastomosis was smaller(OR=0.416,95%CI:0.193~0.895)and lower anastomotic flow rate(OR=0.981,95%CI:0.966~0.997)were risk factors for ineffective thrombolysis of AVF;longer embolization time(OR=1.140,95%CI:1.004~1.296),weaker brachial artery anastomotic pulse(OR=0.358,95%CI:0.129~0.996),longer venous thrombosis in Guiyao(OR=1.961,95%CI:0.963~3.991),AVG thrombolysis was ineffective risk factors.The ROC curve indicated that the best critical points of embolization time,thrombus length,anastomotic inner diameter,and anastomotic flow velocity were 11.5 h,66 mm,4.3 mm,and 52.3 cm/s,respectively,among the relevant factors for predicting the ineffectiveness of AVF thrombolysis;the prediction of ineffectiveness of AVG thrombolysis Among the related factors,the best critical points for embolization time and the length of venous thrombus were 22.5 h and 3.5 mm,respectively.Conclusion:After acute arteriovenous fistula thrombosis in dialysis patients,thrombolytic therapy cannot be blindly carried out to avoid increasing the secondary damage of internal fistula vessels and consuming limited vascular

关 键 词：多普勒超声 动静脉内瘘 血栓 尿激酶 

分 类 号：R692.5[医药卫生—泌尿科学]