自体动静脉内瘘成熟的影响因素

Analysis of prognostic factors for autogenous arteriovenous fistula maturation

目的:分析自体动静脉内瘘(arteriovenous fistula,AVF)成熟的影响因素,寻找更有效的临床及超声评价指标。方法:采用回顾性调查研究,选取2017年1月至2019年6月在武汉市中心医院初次行AVF手术的患者,探讨AVF成熟的影响因素。记录患者的一般资料、血液学资料、术前彩超资料和术后彩超资料。根据内瘘术后物理检查情况、临床使用、术后彩超数据将患者分为内瘘成熟组及未成熟组,对比两组资料之间的差异。采用Logistic回归分析法分析AVF成熟的影响因素,绘制受试者工作特征(ROC)曲线,评估各因素对AVF成熟的预测价值。结果:共纳入研究对象164例,内瘘成熟组110例,未成熟组54例,两组患者在手术动脉直径、手术静脉直径、肱动脉流量、心脏射血分数、收缩压、舒张压及糖尿病病史之间的差异均有统计学意义(均P<0.05),而其他指标如性别、年龄等差异均无统计学意义。多因素Logistic回归分析结果显示,术前手术动脉直径(每增加0.1 mm,OR=1.402,95%CI 1.159~1.697,P=0.001)、手术静脉直径(每增加0.1 mm,OR=1.341,95%CI 1.176~1.528,P<0.001)、心脏射血分数(每增加5%,OR=1.184,95%CI 1.087~1.289,P<0.001)、收缩压(每增加10 mmHg,OR=1.407,95%CI 1.103~1.796,P=0.006)、肱动脉流量(每增加10 ml/mim,OR=1.047,95%CI 1.004~1.091,P=0.034)及糖尿病病史(OR=0.271,95%CI 0.103~0.715,P=0.008)是AVF成熟的独立影响因素。ROC曲线显示术前手术动脉直径(AUC=0.728,95%CI 0.643~0.839,P<0.001)、手术静脉直径(AUC=0.762,95%CI 0.686~0.839,P<0.001)、心脏射血分数(AUC=0.711,95%CI 0.626~0.796,P<0.001)是预测AVF成熟的重要指标。结论:术前手术动脉直径、手术静脉直径、心脏射血分数及糖尿病病史均是AVF成熟的独立影响因素,AVF术前评估中应重视动静脉直径、心脏功能及糖尿病情况。

Objective To analyze the prognostic factor of arteriovenous fistula(AVF)maturation and provide the theoretical basis for the hemodialysis patients'AVF surgery.Methods Retrospective investigation was conducted on patients that underwent AVF surgery in Wuhan Central Hospital from January 2017 to June 2019 as study subjects to investigate the prognostic factor of AVF maturation.The general information,hematological indicators,preoperative and postoperative ultrasound data of patients were recorded.Patients were divided into mature group and immature group according to the physical examination status,functional status and postoperative color doppler ultrasound data after AVF surgery,and the differences between the two groups were compared.Logistic regression analysis was used to analyze the prognostic factors of AVF maturation,and receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of each factor for AVF maturation.Results A total of 164 patients were included,including 110 patients in the mature group and 54 patients in the immature group.There were statistically significant differences between the two groups in surgical vein diameter,surgical artery diameter,brachial artery flow,cardiac ejection fractions,systolic blood pressure,diastolic blood pressure and history of diabetes(all P<0.05),while there were no statistically significant differences in other indicators such as gender,age,etc.Logistic regression analysis showed that preoperative surgical artery diameter(every increase by 0.1 mm,OR=1.402,95%CI 1.159-1.697,P=0.001),surgical vein diameter(every increase by 0.1 mm,OR=1.341,95%CI 1.176-1.528,P<0.001),cardiac ejection fraction(every increase by 5%,OR=1.184,95%CI 1.087-1.289,P<0.001),systolic blood pressure(every increase by 10 mmHg,OR=1.407,95%CI 1.103-1.796,P=0.006),brachial artery flow(every increase by 10 ml/min,OR=1.047,95%CI 1.004-1.091,P=0.034)and history of diabetes(OR=0.271,95%CI 0.103-0.715,P=0.008)were the independent influencing factors for AVF maturation.ROC curve showed that preoperative surgical artery diameter(AUC=0.728,95%CI 0.643-0.839,P<0.001),surgical vein diameter(AUC=0.762,95%CI 0.686-0.839,P<0.001),cardiac ejection fraction(AUC=0.711,95%CI 0.626-0.796,P<0.001)were the important indicators for predicting AVF maturation.Conclusions Preoperative surgical artery diameter,surgical vein diameter,cardiac ejection fraction and diabetes mellitus are the prognostic factors of AVF maturation.In preoperative vascular assessment,attention should be paid to the diameter of target arteries and veins,as well as to the cardiac function and diabetes mellitus of patients.