限流改善血液透析患者头静脉弓狭窄干预后临床结局的研究

Flow reduction improving post-intervention clinical outcomes of cephalic arch stenosis in hemodialysis patients

目的分析限流对血液透析患者合并头静脉弓狭窄临床结局的影响。方法回顾性分析郑州大学第一附属医院2018年3月至2021年12月诊断为头静脉弓狭窄并行经皮腔内血管成形术(PTA)的56例血液透析患者的临床资料,根据是否进行限流分为限流组和未限流组,比较两组靶病变的通畅时间以及患者报告结局(PRO)。采用Kaplan-Meier生存曲线比较两组一期和二期通畅率。结果随访(31.37±2.44)个月,头静脉弓狭窄发生在动静脉通路建立后28(21,39)个月。56例患者中,29例未进行限流操作(未限流组);27例进行了限流操作(限流组),其中12例采用单纯Miller手术限流,10例采用人工血管间置法,5例序贯采用两种方法。限流组中位血流量(2932.0 ml/min)高于未限流组(2103.0 ml/min),差异具有统计学意义(Z=-3.681,P<0.001),限流后中位血流量为984(921,1078)ml/min,比限流前下降67.5%。限流组和未限流组靶病变一期通畅时间分别为(12.25±0.66)个月和(7.30±0.92)个月。限流组的靶病变一期通畅率高于未限流组,差异具有统计学意义(χ^(2)=9.843,P=0.002)。限流组和未限流组靶病变二期通畅时间分别为(36.95±3.40)个月和(26.86±3.01)个月。限流组的靶病变二期通畅率高于未限流组限流组(χ^(2)=5.014,P=0.025),年平均干预次数低于未限流组[(0.94±0.60)次比(1.63±1.42)次,t=2.408,P=0.021]。随时间延长,限流组PRO值增幅低于未限流组,差异具有统计学意义(F=3.642,P=0.036)。结论限流可改善头静脉弓狭窄PTA手术的通畅率和PRO值,降低靶病变干预频率。

Objective To investigate the effects of flow reduction on clinical outcomes of cephalic arch stenosis(CAS)in hemodialysis patients.Methods The clinical data of 56 hemodialysis patients,diagnosed with CAS and conducted percutaneous transluminal angioplasty(PTA)in the First Affiliated Hospital of Zhengzhou University from March 2018 to December 2021,were included retrospectively.According to whether conducted flow reduction,patients were divided into flow reduction group(FR group)and non-flow reduction group(NFR group).Patency time of target lesions and patient-reported outcomes(PRO)of two groups were compared.Kaplan-Meier survival curve was performed to compare the primary and secondary patency rates between the two groups.Results Fllow-up time was(31.37±2.44)months.CAS occurred 28(21,39)months after surgery.Among 56 patients,flow reduction was performed in 27 patients(FR group),and non-flow reduction was performed in 29 patients(NFR group).Among the cases,12 underwent Miller Banding for flow restriction,10 interposition of artificial blood vessels,and 5 both methods sequentially.The median blood flow was significantly higher in the RF group than that in the NRF group(2932.0 ml/min vs 2103.0 ml/min).The difference was statistically significant(Z=-3.681,P<0.001).The median blood flow after flow restriction was 984(921,1078)ml/min,67.5%lower than that before flow restriction.The primary patency time of target lesions in the RF group and NRF group were(12.25±0.66)months and(7.30±0.92)months,respectively.The primary patency rate of the target lesions was higher in the RF group than that in the NRF group,the difference was statistically significant(χ^(2)=9.843,P=0.002).The secondary patency time of the target lesions in the RF group and NRF group were(36.95±3.40)months and(26.86±3.01)months.The secondary patency rate of the target lesions was higher in the RF group than that in the NRF group,the difference was statistically significant(χ^(2)=5.014,P=0.025).The annual average number of interventions was lower in the RF group than that in the NRF group[(0.94±0.60)times vs(1.63±1.42)times,t=2.408,P=0.021].Growth of PRO measurement during follow-up was slower in the RF group than that in the NRF group,and the difference was statistically significant(F=3.642,P=0.036).Conclusions Flow reduction can improve the patency rate and PRO measurement of PTA for the treatment of CAS and lower the frequency of target lesion intervention.