维持性血液透析患者自体动静脉内瘘失功的影响因素、风险预测及中医证候分布

Influencing factors,risk prediction and TCM syndrome distribution of autologous arteriovenous fistula dysfunction in maintenance hemodialysis patients

目的探讨维持性血液透析患者自体动静脉内瘘失功的影响因素、风险预测及中医证候分布情况。方法回顾性分析2017年1月—2022年1月在北京中医药大学东直门医院血液透析中心采用自体动静脉内瘘行维持性血液透析的150例患者临床资料,根据患者自体动静脉内瘘功能状态将其分为失功组和通畅组,分析自体动静脉内瘘失功的影响因素,绘制受试者工作特征曲线(ROC)分析危险因素对维持性血液透析患者自体动静脉内瘘失功的预测价值,比较失功组和通畅组患者中医证候分布情况。结果失功组45例(30%),通畅组105例(70%)。与通畅组比较,失功组患者年龄和体质指数(BMI)较大,活血散结膏使用率较低,导管使用率和透析低血压发生率较高,透析时长较久,血肌酐和血磷水平较高,钙磷乘积较大,白蛋白(ALB)水平较低,差异均有统计学意义(P均<0.05)。多元逐步Logistic分析显示,年龄、透析时长、钙磷乘积、ALB水平和透析低血压是自体动静脉内瘘失功的危险因素,活血散结膏是其保护性因素。ROC结果显示年龄、透析时长和钙磷乘积的截断值依次是64.5岁、21.5个月、61.5 mg/dL,敏感度分别为73.0%,81.1%,56.8%,特异度分别为64.6%,60.6%,80.8%,曲线下面积(AUC)分别为0.723,0.720,0.709。Hosmer-Lemeshow拟合优度检验显示该模型拟合度良好。失功组本虚证中脾肾气虚证占比最高,标实证中血瘀证占比最高。结论年龄、透析时长、钙磷乘积、ALB水平和透析低血压是自体动静脉内瘘失功的危险性因素,活血散结膏是保护性因素,以此构建的风险预测模型具有很好的灵敏度和特异度,预测价值良好,模型拟合度较高。自体动静脉内瘘失功患者本虚以脾肾气虚证多见,标实以血瘀证多见。

Objective It is to explore the influencing factors,risk prediction and traditional Chinese medicine(TCM)syndrome distribution of autologous arteriovenous fistula in maintenance hemodialysis patients.Methods The clinical data of 150 patients who underwent maintenance hemodialysis with autologous arteriovenous fistula in the hemodialysis center of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2017 to January 2022 were retrospectively analyzed.According to their functional status of autologous arteriovenous fistula,they were divided into dysfunction group and patency group.The influencing factors of autogenous arteriovenous fistula dysfunction were analyzed,the working characteristic receiver operating curve(ROC)of the subjects was drawn to analyze the predictive value of risk factors on autogenous arteriovenous fistula dysfunction in maintenance hemodialysis patients,and the distribution of TCM syndromes between the dysfunction group and the patency group was compared.Results There were 45 cases(30%)in the dysfunction group and 105 cases(70%)in the patency group.Compared with the patency group,the patients in the dysfunction group were older in age and higher in BMI,lower in the use rate of Huoxue Sanjie ointment,higher in the use rate of catheters and the incidence of dialysis hypotension,longer in the dialysis time,higher in the levels of blood creatinine and blood phosphorus,higher in the calcium phosphorus product,and lower in the level of albumin(ALB),the differences were all statistically significant(all P<0.05).Multivariate stepwise logistic analysis showed that age,dialysis duration,calcium phosphorus product,ALB and dialysis hypotension were the risk factors of internal fistula dysfunction,Huoxue Sanjie ointment was its protective factor.The results of ROC showed that the cut-off values of age,dialysis duration and calcium phosphorus product were 64.5 years,21.5 months and 61.5 mg/dL respectively,the sensitivity was 73%,81.1%and 56.8%,the specificity was 64.6%,60.6%and 80.8%,and the area under the curve(AUC)were 0.723,0.720 and 0.709 respectively.The Hosmer-Lemeshow goodness-of-fit test showed that the model fit was good.In the dysfunction group,this deficiency syndrome was more common in spleen and kidney qi deficiency syndrome,and excess syndrome is more common in blood stasis syndrome.Conclusion Age,dialysis duration,calcium phosphorus product,ALB and dialysis hypotension are the risk factors of autologous arteriovenous fistula dysfunction,and Huoxue Sanjie ointment is its protective factor.The risk prediction model constructed by this method has good sensitivity and specificity,good prediction value and high fitting degree.Deficiency syndrome is more common in spleen and kidney qi deficiency syndrome,and excess syndrome is more common in blood stasis syndrome in the patients with autologous arteriovenous fistula dysfunction.