自体动静脉内瘘初次通畅时间生存分析和影响因素的前瞻性研究

Prospective study on survival analysis and risk factors of primary patency in hemodialysis patients with autogenous arteriovenous fistula

目的分析行血液透析用自体动静脉内瘘(arteriovenous fistula,AVF)成形术患者内瘘初次通畅时间及危险因素。方法前瞻性收集2016年9月—2019年4月于复旦大学附属华山医院住院并行新建AVF成形术的99例病例资料,随访至2021年11月。收集并分析患者一般资料、合并疾病、手术相关信息和内瘘初次通畅时间等。采用Kaplan-Meier法对内瘘进行生存分析,利用单因素及多因素Cox回归模型法分析影响内瘘初次通畅时间的因素。结果内瘘12、24和36个月初次通畅率分别为77.5%、71.5%和65.1%,中位初次通畅时间为35.85个月。单因素Cox回归分析结果显示年龄、文化程度、肾脏科随访、糖尿病、首次内瘘手术、手术位置、中心静脉置管、吻合血管动脉内径和吻合血管静脉内径为影响内瘘初次通畅时间进入终点事件的共同影响因素。多因素Cox回归分析结果显示糖尿病、首次内瘘手术和吻合血管静脉内径为影响内瘘初次通畅时间的独立影响因素。结论对于新建内瘘患者,合并糖尿病、首次内瘘手术以及吻合血管静脉内径是内瘘初次通畅时间的独立危险因素。

Objective To investigate the primary patency and risk factors in hemodialysis patients with autogenous arteriovenous fistula(AVF).Methods The patients with new creation of AVF at a single institution from Sep 2016 to Apr 2019 were enrolled in this prospective study.Clinical data including demographic data,ultrasound data,concomitant diseases,operative information and primary patency were collected and analyzed.Kaplan-Meier survival curves and Cox proportional hazard models were used to determine the primary patency and associated factors.Results The primary patency rates for 1,2 and 3 years were 77.5%,71.5%and 65.1%,respectively.The median time of primary patency was 35.85 months.Univariate Cox regression reveals that age,education level,nephrology follow-up,diabetes,initial surgery,fistula site,central venous catheter,arterial diameter and venous diameter were the composite risk factors of primary patency.After adjustment,multivariate Cox regression revealed that diabetes,initial surgery and venous diameter were the independent factors for AVF primary patency.Conclusion Diabetes,initial surgery and venous diameter were significantly associated with primary patency in newly created AVF.