经皮腔内血管成形术后内瘘再狭窄的相关危险因素探讨  

Analysis of influencing factors for restenosis after percutaneous transluminal angioplasty in hemodialysis patients

作　　者：詹申 赵彬 张丽红[1] 王玉柱[1] Zhan Shen;Zhao Bin;Zhang Li-hong;Wang Yu-zhu(Department of Nephrology,Haidian District,Third Hospital of Peking University(Haidian Hospital),Beijing 100080,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

出　　处：《临床肾脏病杂志》2024年第3期200-208,共9页Journal Of Clinical 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：目的探讨经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)后再狭窄的相关危险因素,为延长内瘘使用时间提供诊疗依据。方法回顾性纳入2020年1月1日至2021年1月1日在北京大学第三医院海淀院区肾内科因动静脉内瘘狭窄接受超声引导下PTA治疗并规律随访的血液透析患者335例,收集其基本数据包括基础病史、合并症、相关血清学指标、内瘘手术操作及术后随访资料,采用Cox比例风险模型分析影响PTA术后内瘘再狭窄的危险因素。结果共纳入335例患者,其中男187例(55.82%),女148例(44.18%)。PTA术后6个月时的初级通畅率为77.31%,12个月时的初级通畅率为50.15%。Kaplan-Meier生存分析结果显示术后12个月,内瘘类型为人工血管动静脉内瘘的患者初级通畅率在随访时间内明显低于自体动静脉内瘘的患者(Log-rankχ2=719.522,P<0.001);陈旧性病变患者的初级通畅率在随访时间内明显低于新发病变的患者(Log-rankχ2=23.106,P<0.001);PTA麻醉方式为局部麻醉的患者初级通畅率在随访时间内明显低于臂丛麻醉患者(Log-rankχ2=27.415,P<0.001)。多因素Cox风险回归分析结果显示,PTA术后6个月时,陈旧性病变(HR=0.393,95%CI:0.237~0.650,P<0.001)、PTA手术的麻醉方式为局部麻醉(HR=3.223,95%CI:1.956~5.311,P<0.001)、血小板计数(HR=1.005,95%CI:1.001~1.008,P=0.008)是影响PTA术后患者发生内瘘处再狭窄病变的独立危险因素。PTA术后12个月时,内瘘类型为人工血管动静脉内瘘(HR=0.550,95%CI:0.387~0.782,P=0.001)、陈旧性病变(HR=0.587,95%CI:0.422~0.815,P=0.002)以及PTA手术的麻醉方式为局部麻醉(HR=2.359,95%CI:1.686~3.302,P<0.001)是影响PTA术后患者发生内瘘处再狭窄病变的独立危险因素。结论影响血液透析患者PTA术后再狭窄的危险因素较多,其中病变类型、麻醉方式、内瘘类型可能是导致PTA术后再狭窄的独立危险因素,在临床中我们需要密切观察和监测此类高危�Objective To explore the influencing factors of restenosis after percutaneous translu-minal angioplasty in hemodialysis(HD)patients and provide a basis for predicting the risk of dysfunction and prolonging the service time.Methods Retrospective analysis was performed on the clinical and fol-low-up data of 335 patients who underwent percutaneous transluminal angioplasty(PTA)in Haidian Dis-trict,The Third Hospital of Peking University(Haidian Hospital)from January 12020 to January 12021 as study.Results There were 187 males(55.8%)and 148 females(44.2%).Kaplan-Meier survival analysis indicated that primary patency rates were 77.31%and 50.15%at Month 6/12 post-PTA.At Month 212 post-PTA,the risk of restenosis was significantly higher in AVG patients than that of AVF(Log-rankχ=719.522,P<0.001).The risk of restenosis in patients with old lesions was significantly higher than that of those with new lesions(Log-rankχ2=23.106,P<0.001).The risk of restenosis in patients with local anesthesia was significantly higher than that of those with brachial plexus anesthesia(Log-rankχ2=27.415,P<0.001).Multivariate Cox proportional risk regression analysis at Month 6 revealed that old/new lesions(HR=0.393,95%CI:0.237-0.650,P<0.001),type/mode of anesthesia(HR=3.223,95%CI:1.956-5.311,P<0.001)and platelet count(HR=1.005,95%CI:1.001-1.008,P=0.008)were in-dependent risk factors for restenosis post-PTA.Multivariate Cox proportional risk regression analysis at Month 12 indicated that type of fistula AVG(HR=0.550,95%CI:0.387-0.782,P=0.001),old/new le-sions(HR=0.587,95%CI:0.422-0.815,P=0.002)and type/mode of anesthesia(HR=2.359,95%CI:1.686-3.302,P<0.001)were independent risk factors for restenosis post-PTA.Conclusion Multiple factors may affect restenosis post-PTA in HD patients.And type/mode of anesthesia,old/new lesions and type of fistula are independent risk factors for restenosis post-PTA.Preoperative examinations and postop-erative comprehensive follow-ups may prevent fistula dysfunction and help to formulate accurate surgical plans

关 键 词：动静脉内瘘 经皮腔内血管成形术 再狭窄 危险因素 

分 类 号：R459.5[医药卫生—治疗学]