年龄是影响桡动脉⁃头静脉内瘘成熟的危险因素

Increasing age related to reduce of primary functional maturation of wrist arteriovenous fistula

目的:既往研究发现老年患者腕部桡动脉⁃头静脉内瘘(RCAVF)成熟率较低,本文旨在分析年龄与内瘘成熟的相关性。方法:回顾性队列研究265例RCAVF手术患者。术前超声测量血管内径,术后至少随访3个月。多变量Logistic回归分析影响RCAVF成熟的危险因素。将患者按年龄分为四组(≤29岁、30~49岁、50~69岁和70~89岁),经过多模型校正及P趋势检验,分析年龄增长与RCAVF不成熟风险的关系。结果:术后4~6周按照腕部RCAVF是否达到成熟标准,将患者分成熟组218例,不成熟组47例。随年龄升高与成熟相关的OR值降低,多模型校正P趋势均<0.05。经多因素模型校正,年龄每增加20岁,不成熟的风险显著增加,所得的OR值均>1.6。结论:腕部RCAVF的不成熟风险随着年龄的增加而显著增加。年龄与RCAVF功能成熟降低存在线性趋势。年龄每增加20岁,不成熟风险增加60%以上。

Objective:Previous studies have found the maturity rate of radio⁃cephalic arteriovenous fistula(RCAVF)in elderly patients is low.The objective of the study was to perform trend analysis to verify relationship between increasing age and functional maturation of RCAVF.Methodology:Our retrospective cohort study enrolled and analyzed 265 follow⁃up cases underging first AVF creation.The artery and vein sizes were measured by ultrasound.After surgery,we performed a follow⁃up minimum of 3 months􀆰Multivariable logistic regression analysis was to identify whether age was an independent risk factor of maturation.Participants were categorized into four groups(Age≤29y,30~49y,50~69y,and 70~89y)􀆰We adjusted some confounders in four logistic models and primary analyses were based on building ordered age categories models and tested P values for trends to estimate the relationship between each 20 years increase in age and immaturity risk of RCAVF.Results:4⁃6 weeks after the surgery,the wrist RCAVF mature group included 218 cases,and immature group included 47 cases􀆰Odds ratios(OR)value associated with immaturity rate were reduced with increasing age,and P values for trend(<0.05)were all observed in four different models.Each 20 years increase in age was significantly associated with higher incidence of immaturity odds ratios(OR values more than 1.6)after adjusting multivariate models.The smooth curves for the relationship between increasing age and immaturity were shown.Conclusion:This study suggested that significantly higher immaturity risk of wrist RCAVF associated with exposure to age.Linear exposure⁃response relations between age and incident immaturity was proved.For every 20 years of age the risk of immaturity increases by more than 60%.