经皮腔内血管成形术治疗动静脉内瘘狭窄术后影响通畅时间的列线图模型构建  

Construction of a nomograph model of impact of patency time after percutaneous balloon dilation for arteriovenous fistula stenosis

作　　者：束长东 梅吉本 陈忠辉 桂东东 Shu Chang-dong;Mei Ji-ben;Chen Zhong-hui;Gui Dong-dong(Department of Nephrology,Xuancheng People’s Hospital,Wannan Medical College,Xuancheng 242000,China;Department of Ultrasonography,Xuancheng People’s Hospital,Wannan Medical College,Xuancheng 242000,China)

机构地区：[1]宣城市人民医院皖南医学院附属宣城医院肾内科,宣城242000 [2]宣城市人民医院皖南医学院附属宣城医院超声科,宣城242000

出　　处：《临床肾脏病杂志》2025年第2期98-107,共10页Journal Of Clinical Nephrology

摘　　要：目的探究经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)治疗动静脉内瘘(arteriovenous fistula,AVF)狭窄术后影响通畅时间的影响因素,并构建列线图预测模型。方法选择2019年2月至2022年5月于宣城市人民医院皖南医学院附属宣城医院经血管超声评估为AVF狭窄并行PTA治疗的患者共125例为研究对象纳入训练集;按照相同标准另选2022年6月至2022年12月于宣城市人民医院皖南医学院附属宣城医院皖南医学院附属宣城医院经血管超声评估为AVF狭窄并行PTA治疗的患者42例纳入验证集,以验证预测模型的有效性。采用多因素Cox分析影响PTA术后内瘘一期通畅时间的危险因素;使用逐步回归方法进一步筛选重要因素,构建列线图预测模型并评价。结果PTA术后3个月患者的初级通畅率为96.0%,术后6个月为85.6%,术后12个月为64.0%。多因素Cox分析结果显示,糖尿病(OR=1.714,95%CI:1.034~2.308)、AVF建立时间(OR=4.190,95%CI:1.684~8.807)、狭窄长度(OR=2.008,95%CI:1.066~3.050)、最大球囊压力(OR=2.342,95%CI:1.107~4.078)以及血镁(OR=0.722,95%CI:0.620~0.823)均是术后内瘘一期通畅时间短的独立影响因素(P<0.05)。逐步回归分析筛选出AVF建立时间、狭窄长度、最大球囊压力和血镁与术后内瘘一期通畅时间关联最大。模型的评价结果显示,其区分度良好、准确度较高、有效性较好。根据最佳临界值,将患者分为3个风险组,依次为<112分(低危)、≥112分且<152分(中危)、≥152分(高危)。结论AVF建立时间、狭窄长度、最大球囊压力以及血镁与术后内瘘一期通畅时间关联最大。基于危险因素构建的列线图预测模型具有一定的临床价值。Objective To explore the influencing factors of patency time after percutaneous transluminal angioplasty(PTA)for arteriovenous fistula(AVF)stenosis and construct a nomograph prediction model.Methods From February 2019 to May 2022,125 patients receiving vascular ultrasonic evaluations and undergoing PTA for AVF stenosis were selected as study subjects and included into training set.According to the same criteria,from June to December 2022,another 42 patients(n=42)receiving vascular ultrasound included into validation set for verifying the effectiveness of the prediction model.Multivariate Cox analysis was utilized for identifying the risk factors affecting primary patency time of internal fistula post-PTA.Stepwise regression was employed for further screening important factors and constructing and validating a nomogram prediction model.Results Primary patency rate was 96.0%at Month 3,85.6%at Month 6 and 64.0%at Month 12 post-PTA.Multivariate Cox analysis results indicated that diabetes mellitus(OR=1.714,95%CI:1.034~2.308),AVF establishment time(OR=4.190,95%CI:1.684~8.807),stenotic length(OR=2.008,95%CI:1.066~3.050),maximal balloon pressure(OR=2.342,95%CI:1.107~4.078)and blood magnesium(OR=0.722,95%CI:0.620~0.823)were independent influencing factors for short patency time of internal fistula post-PTA(P<0.05).Stepwise regression analysis identified that time of AVF establishment,stenotic length,maximal balloon pressure and blood magnesium were most closely correlated with the first stage patency time of postoperative internal fistula.The evaluation results of the model hinted at a decent discrimination,a high accuracy and great effectiveness.Patients were assigned into three risk groups based on an optimal threshold,namely<112 points(low risk),≥112 points and<152 points(medium risk)and≥152 points(high risk).Conclusion Time of AVF establishment,length of stenosis,maximal balloon pressure and blood magnesium are all most correlated with the first stage patency time of postoperative internal fistula.The nomogram pr

关 键 词：经皮腔内血管成形术 动静脉内瘘狭窄 初级通畅率 列线图模型 

分 类 号：R692.5[医药卫生—泌尿科学] R459.5[医药卫生—外科学]