术前超声预测动静脉内瘘狭窄经皮腔内血管成形术后再狭窄的价值  

Predictive value of preoperative ultrasound for restenosis of arteriovenous fistula after percutaneous transluminal angioplasty:a report of 225 cases

作　　者：舒启沛 张君 尹娜 张军 史琳 鄢玲 郭燕丽 SHU Qipei;ZHANG Jun;YIN Na;ZHANG Jun;SHI Lin;YAN Ling;GUO Yanli(Department of Ultrasonography,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,China;Department of Nephrology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院超声科,重庆 [2]陆军军医大学(第三军医大学)第一附属医院肾科,重庆

出　　处：《陆军军医大学学报》2025年第8期870-875,共6页Journal of Army Medical University

基　　金：重庆市技术创新与应用发展专项重点项目(CSTB2022TIAD-KPX0153);重庆英才计划(425Z2K1)。

摘　　要：目的 探讨术前超声对自体动静脉内瘘(arteriovenous fistula,AVF)狭窄行经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)术后再狭窄的预测价值。方法 采用病例对照研究的方法,收集2023年1月至2024年5月陆军军医大学第一附属医院肾科、超声科225例接受PTA的AVF狭窄患者的临床及超声资料,根据术后3个月内AVF是否再狭窄分为通畅组(n=204)与再狭窄组(n=21)。对2组患者术前临床资料及超声参数进行组间比较,经多因素二元Logistic回归分析预测AVF狭窄行PTA术后再狭窄的相关因素;绘制受试者工作特征曲线(ROC),评估术前AVF血管狭窄长度预测AVF狭窄行PTA术后再狭窄的价值。结果 2组术前AVF血管狭窄处内径、狭窄长度、狭窄数量、内膜厚度、肱动脉流量比较差异均有统计学意义(P<0.05)。术前AVF血管狭窄长度(P<0.001,OR=1.856,95%CI:1.350~2.552)是预测AVF狭窄行PTA术后再狭窄的独立相关因素。术前AVF血管狭窄长度预测AVF狭窄行PTA术后再狭窄的曲线下面积(AUC)为0.868(95%CI:0.784~0.953,P<0.001),灵敏度为85.7%,特异度为80.4%。结论 术前AVF血管狭窄长度可能是预测AVF狭窄行PTA术后再狭窄的独立相关因素。Objective To explore the value of preoperative ultrasound examination in the prediction of restenosis of arteriovenous fistula(AVF)after percutaneous transluminal angioplasty(PTA)in hemodialysis patients.Methods A case-control trial was conducted on 225 hemodialysis patients who undergoing PTA due to AVF in our hospital January 2023 to May 2024.After 3 months of follow-up,they were divided into a patency group(n=204)and a restenosis group(n=21)according to the occurrence of postoperative restenosis.The preoperative clinical data and ultrasound parameters were compared between the groups.Binary logistic regression analysis was used to identify the independent factors for AVF restenosis after PTA.Receiver operating characteristic(ROC)curve was drawn to evaluate the value of preoperative stenosis length in the prediction of the restenosis after PTA.Results There were significant differences in preoperative internal diameter at the site of stenosis,stenosis length,stenosis number,intimal thickness,and brachial artery flow between the 2 groups(P<0.05).Preoperative stenosis length(OR=1.856,95%CI:1.350~2.552,P<0.001)was an independent factor of AVF restenosis in hemodialysis patients after PTA.ROC curve analysis showed that the area under the curve of preoperative stenosis length in predicting restenosis after PTA was 0.868(95%CI:0.784~0.953,P<0.001),with a sensibility and specificity of 85.7%and 80.4%,respectively.Conclusion Preoperative stenosis length may be an independent factor for AVF restenosis after PTA in hemodialysis patients.

关 键 词：超声 狭窄长度 动静脉内瘘 经皮腔内血管成形术 再狭窄 

分 类 号：R445.1[医药卫生—影像医学与核医学] R619[医药卫生—诊断学] R654.3[医药卫生—临床医学]