静脉扩张性与动静脉内瘘成熟的相关性分析

Correlation between venous distensibility and maturation of arteriovenous fistula

目的探讨应用超声评估束臂前、后头静脉直径和静脉扩张性与腕部桡动脉-头静脉内瘘(radiocephalic arteriovenous fistula,RC-AVF)成熟的关系。方法91例接受RC-AVF手术患者,术前行超声检查,评估止血带束臂前、后头静脉直径和头静脉扩张性,观察术后6周RC-AVF成熟情况,并根据RC-AVF成熟情况分为成熟组70例及未成熟组21例,比较2组患者一般资料及束臂前、后头静脉直径和头静脉扩张性,采用多因素logistic回归分析预测RC-AVF成熟的影响因素;绘制ROC曲线,评估束臂后头静脉直径和头静脉扩张性预测RC-AVF成熟的价值。结果成熟组年龄、性别比例、慢性肾衰竭病因和中心静脉置管史与未成熟组比较差异均无统计学意义(P>0.05);成熟组束臂前、后头静脉直径[(2.14±0.58)、(2.86±0.61)mm]和头静脉扩张性[(0.71±0.27)mm]均大于未成熟组[(1.81±0.30)、(2.20±0.34)、(0.38±0.16)mm](P<0.05);束臂后头静脉直径(OR=3.463,95%CI:1.935~6.198,P<0.001)和头静脉扩张性(OR=3.887,95%CI:2.074~7.284,P<0.001)是预测RC-AVF成熟的影响因素;束臂后头静脉直径最佳截断值>2.4 mm时,预测RC-AVF成熟的AUC为0.837(95%CI:0.745~0.906,P<0.001),灵敏度为72.86%,特异度为84.29%;头静脉扩张性最佳值断值>0.4 mm时,预测RC-AVF成熟的AUC为0.894(95%CI:0.812~0.949,P<0.001),灵敏度为88.57%,特异度为85.71%。结论束臂后头静脉直径>2.4 mm和头静脉扩张性>0.4 mm是预测腕部RC-AVF成熟的独立危险因素。

Objective To investigate the relationship of the diameter of the cephalic vein before and after tourniquet test as well as the venous distensibility on ultrasound with the maturation of the wrist radiocephalic arteriovenous fistula(RC-AVF).Methods Ninety-one patients underwent ultrasonography before surgery for RC-AVF to measure the diameter of the cephalic vein before and after tourniquet test and the venous distensibility,and were divided into mature group(n=70)and immature group(n=21)according to RC-AVF maturation evaluation 6 weeks after surgery.The general data,the diameter of the cephalic vein before and after tourniquet test,and venous distensibility were compared between two groups.Multivariate logistic regression analysis was used to assess the influencing factors for RC-AVF maturation.ROC was drawn to evaluate the values of the diameter of the cephalic vein before and after tourniquet test as well as the venous distensibility to predicting the RC-AVF maturation.Results There were no significant differences in age,gender ratio,etiology of chronic renal failure,and history of central venous catheterization between two groups(P>0.05).Mature group had longer diameters of the cephalic vein before and after tourniquet test((2.14±0.58),(2.86±0.61)mm)and stronger venous distensibility((0.71±0.27)mm)than immature group((1.81±0.30),(2.20±0.34),(0.38±0.16)mm)(P<0.05).The diameter of the cephalic vein after tourniquet test(OR=3.463,95%CI:1.935-6.198,P<0.001)and the venous distensibility(OR=3.887,95%CI:2.074-7.284,P<0.001)were the influencing factors for predicting RC-AVF maturation.When the optimal cut-off value of the cephalic vein after tourniquet test was>2.4 mm,the AUCfor predicting RC-AVF maturation was 0.837(95%CI:0.745-0.906,P<0.001),with the sensibility and specificity of 72.86%and 84.29%;when the optimal cut-off value of venous distensibility was>0.4 mm,the AUCfor predicting RC-AVF maturation was 0.894(95%CI:0.812-0.949,P<0.001),with the sensibility and specificity of 88.57%and 85.71%.Conclusion The diameter of the cephalic vein>2.4 mm after tourniquet test and the venous distensibility>0.4 mm are the independent risk factors for predicting RC-AVF maturation.