个体化预测维持性血液透析发生动静脉内瘘栓塞风险的列线图模型建立

Establishment of a nomogram model for individualized prediction of the risk of arteriovenous fistula embolism occurrence in MHD patients

目的构建预测慢性肾衰竭(CRF)行维持性血液透析发生动静脉内瘘(AVF)栓塞风险的列线图模型,并评估模型的区分度和一致性。方法选取2017年9月至2021年3月在本院行维持性血液透析的CRF患者254例,依据是否发生AVF栓塞,分为AVF栓塞组54例,AVF通畅组200例。采用Logistic回归分析影响CRF行维持性血液透析发生AVF栓塞的危险因素。采用R软件构建预测CRF行维持性血液透析发生AVF栓塞风险的列线图模型。结果AVF栓塞组糖尿病比例、透析后低血压比例、血液高凝状态比例、钙磷乘积、血磷水平明显高于AVF畅通组(P<0.05),使用左卡尼汀比例明显低于AVF畅通组(P<0.05)。多因素Logistic回归分析结果显示,糖尿病、透析后低血压、血液高凝状态、钙磷乘积高是影响CRF行维持性血液透析发生AVF栓塞的危险因素(P<0.05),使用左卡尼汀是影响CRF行维持性血液透析发生AVF栓塞的保护因素(P<0.05)。列线图模型预测CRF行维持性血液透析发生AVF栓塞风险的校准曲线,预测值与实际值基本一致,且ROC曲线下面积为0.849(95%CI:0.790~0.909),区分度较优。结论本研究构建的预测CRF行维持性血液透析发生AVF栓塞风险的列线图模型,具有较好的区分度和一致性。

Objective To construct a nomogram model for predicting the risk of arteriovenous fistula(AVF)embolism in patients with chronic renal failure(CRF)undergoing maintenance hemodialysis,and to evaluate the discrimination and consistency of the model.Methods A total of 254 CRF patients who underwent maintenance hemodialysis in our hospital from September 2017 to March 2021 were selected and divided into AVF embolization group of 54 cases and AVF unobstruction group of 200 cases according to whether AVF embolism occurred.Logistic regression was performed to analyze the risk factors of AVF embolism in CRF maintenance hemodialysis,and the R software was used to construct a nomogram model for predicting the risk of AVF embolism in CRF patients who underwent maintenance hemodialysis.Results In the AVF embolization group,the proportion of diabetes mellitus,the proportion of hypotension after dialysis,the proportion of blood hypercoagulability,calcium-phosphorus product,and serum phosphorus level were significantly higher than those in the AVF unobstruction group(P<0.05),while the proportion of L-carnitine use was significantly lower than that in the AVF unobstruction group(P<0.05).The results of multivariate logistic regression analysis showed that diabetes,post-dialysis hypotension,blood hypercoagulability,and high calcium-phosphorus product were risk factors for AVF embolism in CRF patients with maintenance hemodialysis(P<0.05),while the use of L-carnitine was a protective factor affecting the occurrence of AVF embolism in CRF patients with maintenance hemodialysis(P<0.05).The predicted value of the calibration curve of the nomogram model predicting the risk of AVF embolism in CRF patients with maintenance hemodialysis was basically consistent with the actual value,and the area under the receiver operating characteristic(ROC)curve was 0.849(95%CI:0.790-0.909)with a better discrimination.Conclusion The nomogram model constructed in this study showed good discrimination and consistency for predicting the risk of AVF embolism in CRF patients undergoing maintenance hemodialysis.