桡动脉近肘部管径、年龄及eGFR联合预测桡动脉-头静脉自体动静脉内瘘成熟  

Combined diameter of radial artery near elbow,age and eGFR for prediction radiocephalic autogenous arteriovenous fistula

作　　者：丛瑞 于文涛 石莎莎[1] CONG Rui;YU Wen-tao;SHI Sha-sha(Department of Ultrasound,The Second Hospital of Dalian Medical University,Dalian 116023,Liaoning,China;First Department of General Surgery,The Fifth People’s Hospital of Dalian,Dalian 116081,Liaoning,China)

机构地区：[1]大连医科大学附属第二医院超声科,辽宁大连116023 [2]大连市第五人民医院普外一科,辽宁大连116081

出　　处：《生物医学工程与临床》2024年第1期74-80,共7页Biomedical Engineering and Clinical Medicine

摘　　要：目的研究影响桡动脉-头静脉自体动静脉内瘘(RCAVF)成熟因素,联合显著相关因素预测成熟可能性。方法选择2017年7月至2019年12月在大连医科大学附属第二医院首次行RCAVF手术并成功患者257例,其中男性169例,女性88例;年龄24~90岁,平均年龄59.4岁;病程0.81~5.00年,平均病程3.53年;高血压217例(84.4%),糖尿病166例(64.6%)。术前行血管超声检查,记录患者基本信息(年龄、性别)、基础疾病(高血压、糖尿病及肾脏疾病)及血清学指标[尿素、肌酐、尿酸、胱抑素C及肾小球滤过率(e GFR)]。术后连续6个月随访RCAVF成熟情况,采用单因素Logistic回归及多因素Logistic回归分析影响RCAVF成熟因素,获取显著性相关因素,绘制受试者工作特性(ROC)曲线,获得曲线下面积(AUC)、最佳临界值、灵敏度及特异度。根据最佳临界值,将多因素差异有统计意义的指标采用联合方式,获得联合诊断效能。结果行左前臂造瘘者210例(81.7%),右前臂造瘘者47例。RCAVF术后均获得成功。随访6个月内达到临床成熟者为182例,未达到临床成熟者为75例。RCAVF未成熟组年龄、eGFR高于成熟组(年龄:P=0.036;eGFR:P=0.008),而RCAVF成熟组桡动脉近腕部管径及桡动脉近肘部管径、肌酐均高于未成熟组(桡动脉近腕部及近肘部管径均P<0.001;肌酐:P=0.002),差异均有显著统计学意义。单因素Logistic回归分析显示,年龄、桡动脉近腕部及近肘部管径、头静脉近肘部管径、肌酐、e GFR与RCAVF成熟显著相关(P<0.05);多因素Logistic回归分析结果显示,年龄、eGFR为RCAVF成熟阻碍因素,桡动脉近肘部管径为促进因素(P<0.05)。采取联合预测,获得最高AUC值为0.661,最高特异度可达94.29%,最高灵敏度可达96.00%。结论将桡动脉近肘部管径、年龄与eGFR三者联合预测RCAVF成熟,可获取较好的诊断效能、灵敏度及特异度,为评估患者是否适合采用RCAVF进行透析提供参考。Objective To identify factors affecting the maturity of radiocephalic autogenous arteriovenous fistula(RCAVF),and predict the possibility of maturity with significant correlation factors.Methods From July 2017 to December 2019,a total of 257 end-stage renal disease patients with newly created RCAVF were enrolled,which included 169 males and 88 females;aged 24-90 years old with mean age of 59.4 years old;course of disease was 0.81-5.00 years with mean course of 3.53 years.There were 217 cases(84.4%)of hypertension and 166 cases(64.6%)of diabetes.The preoperative vascular ultrasonography was performed to record basic information(age,gender),basic diseases(hypertension,diabetes and kidney disease)and serological indicators[urea,creatinine,uric acid,cystatin C and glomerular filtration rate(eGFR)].The maturation of RCAVF was followed up for 6-month after operation,the univariate logistic regression and multivariate logistic regression were used to analyze factors affecting maturation of RCAVF,and the significant related factors were obtained.The receiver operating characteristic(ROC)curve was drawn to obtain area under curve(AUC),optimal critical value,sensitivity and specificity.According to the optimal critical value,the indexes with statistical significance of multi-factor differences were combined to obtain the combined diagnostic efficacy.Results The RCAVF of the left forearm was performed in 210 cases(81.7%),and the right forearm was performed in 47 cases.All of the operation were was successful.There were 182 cases were matured(mature group),and 75 with immature(immature group)after 6-month of follow-up.The age and eGFR of RCAVF immature group were higher than those of mature group(age:P=0.036;eGFR:P=0.008).In RCAVF mature group,the diameter of radial artery near wrist and diameter of radial artery near elbow and creatinine were statistically significantly higher than those in immature group(diameter of radial artery near wrist and elbow were P<0.001;creatinine:P=0.002).The univariate Logistic regression showe

关 键 词：桡动脉-头静脉自体动静脉内瘘 超声检查 临床资料 影响因素 

分 类 号：R692.5[医药卫生—泌尿科学]