维持性血液透析患者AVF早期失功的危险因素分析

Analysis of the correlation between the risk of early AVF failure and intraoperative blood flow and its risk factors in maintenance hemodialysis patients

目的探讨维持性血液透析患者动静脉内瘘(AVF)早期失功的危险影响因素。方法选取2017年1月至2021年3月在本院拟行维持性血液透析治疗的276例患者为研究对象,AVF建立后随访3个月,最终纳入258例患者。根据患者AVF功能分为失功组(100例)和通畅组(158例);采用logistic回归分析AVF失功的影响因素,构建维持性血液透析患者AVF早期失功风险的预测模型并分析其预测效能。结果两组患者的动脉粥样硬化、AVF吻合口长度、术中血流量、总胆固醇、血小板计数、纤维蛋白原、血红蛋白、钙磷乘积水平比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示:动脉粥样硬化(OR=2.910)、术中低血流量(OR=1.123)、总胆固醇(OR=1.012)、高血小板计数(OR=1.893)、纤维蛋白原(OR=1.429)、钙磷乘积(OR=2.721)是AVF早期失功的危险因素(均P<0.05);据此构建的预测模型预测AVF失功的受试者工作特征(ROC)曲线下面积为0.938(95%CI:0.810~0.973),灵敏度为86.00%,特异度为97.47%。结论术中血流量、总胆固醇、血小板计数、纤维蛋白原、钙磷乘积是影响AVF失功的影响因子,根据上述指标建立的列线图模型可用于维持性血液透析患者AVF早期失功的预测。

Objective To investigate the risk factors of early failure of arteriovenous fistulas(AVF)in maintenance hemodialysis patients.Methods From January 2017 to March 2021,276 patients who planned to undergo maintenance hemodialysis in our hospital were selected as the research objects.All patients were followed up for 3 months after the establishment of AVF.Finally,258 patients were included,According to AVF function,patients were divided into failure group(100 cases)and patency group(158 cases).Logistic regression equation was used to analyze the influencing factors of AVF failure,to build a predictive model for the risk of early failure of AVF in maintenance hemodialysis patients,and to analyze its predictive performance.Results There were statistically significant differences in atherosclerosis,AVF anastomotic length,intraoperative blood flow,total cholesterol,platelet count,fibrinogen,hemoglobin and product levels of calcium and phosphorus between two groups(all P<0.05).Multivariate logistics regression analysis showed:atherosclerosis(OR=2.910),intraoperative low blood flow(OR=1.123),total cholesterol(OR=1.012),high Platelet count(OR=1.893),fibrinogen(OR=1.429),calcium-phosphorus product(OR=2.721)were risk factors for early failure of AVF(all P<0.05).The area under the curve was 0.938(95%CI:0.81-0.973),the sensitivity was 86.00%,and the specificity was 97.47%.Conclusions Intraoperative blood flow,total cholesterol,platelet count,fibrinogen,and calcium-phosphorus product are the influencing factors of AVF failure.The class line graph model established according to the above indicators can be used to predict the early failure of AVF in maintenance hemodialysis patients.