影响前臂动静脉内瘘早期通畅率的危险因素分析

    Establishment of model predicting early patency rate of forearm arteriovenous fistula

    • 摘要: 目的 探讨影响尿毒症患者动静脉内瘘手术成功的危险因素,建立预测手术成功的回归模型。方法 回顾性分析2015年1月至2017年11月在龙岩市第二医院肾内科诊断为终末期肾病患者共108例,收集患者基本资料以及彩超下的血管内径、流速、动脉内中膜厚度等指标;由2个具有3年以上血管通路经验的肾内科医师完成前臂动静脉内瘘手术。将手术的成功与否作为应变量,对各自变量进行单因素筛选分析,将有意义的自变量进一步行多因素非条件Logistic回归分析,建立Logistic回归模型,计算各因素的优势比(OR),并应用受试者工作特征(ROC)曲线评价该模型判断手术成功率预测的准确性、灵敏度及特异性。结果 经单因素Logistic回归分析,单因素分析比较显示手术前1 d至手术当天平均收缩压(P=0.001)、纤维蛋白原(P=0.016)、总胆固醇(P=0.003)、是否存在糖尿病(P=0.000)、桡动脉内径(P=0.017)、头静脉内径(P=0.000)、动脉流速(P=0.000)为影响手术成功的因素。将指标引入多因素非条件Logistic回归分析得出回归模型:Logit P=15.637+1.178×总胆固醇-0.071×桡动脉流速-81.642×头静脉内径。绘制该模型对手术成功率预判的受试者工作特征曲线(ROC曲线),曲线下面积(AUC)(95%可信区间)分别是0.888 3(0.768 3 To 1.008),P<0.001,灵敏度83.33%,特异度94.44%。本预测模型方程对动静脉内瘘手术预测的准确率96.3%。结论 本文应用Logistic回归分析方法综合临床多项指标,建立手术成功预测的模型,利用ROC曲线判断其预测效能,已达到提高手术的阳性预测值的目的。本研究是较为新颖的临床尝试,基于无创、简便易行、经济实惠、临床实用性高的彩超而建立,该模型对预测动静脉内瘘手术的早期成功率有一定的预测效果。

       

      Abstract: Objective To explore the risk factors influencing the surgical success of arteriovenous fistula in patients with uremia, and establish the regression model predicting the surgical success. Methods 108 patients with end-stage nephropathy admitted to Department of Nephrology, Longyan Second Hospital from Jan. 2015 to Nov. 2017 were retrospectively analyzed. The patients' basic information, and vascular inner diameter, velocity and arterial intima-media thickness under the color ultrasound were collected. The forearm arteriovenous fistula was made by 2 skilled nephrologic physicians. The surgical success served as dependent variable, and each independent variable was subjected to the univariate analysis. The meaningful independent variables were given the multivariate non-conditioned Logistic regression analysis, and the Logistic regression model was creased. OR of each factor was calculated, and receiver operating characteristic curve (ROC) was used to evaluate the accuracy, sensitivity and specificity of the model predicting the surgical success rate. Results The univariate Logistic regression analysis revealed that the average systolic pressure (P=0.001), fibrinogen (P=0.016), total cholesterol (P=0.003), diabetic mellitus (P=0.000), inner diameter of radial artery (P=0.017), inner diameter of cephalic vein (P=0.000), and arterial velocity (P=0.000) were the factors influencing the surgical success. The regression model was built up by introducing the factors into the multivariate unconditioned Logistic regression analysis:Logit P=15.637+1.178×Total cholesterol-0.071×Radial artery velocity-81.642×Inner diameter of cephalic vein. The ROC for the model predicting the surgical success was drawn, and the area under the ROC (95% confidence interval) was 0.888 3 (0.768 3 to 1.008) (P<0.001), sensitivity was 83.33%, and specificity was 94.44%. The accuracy of the model predicting the surgical success of arteriovenous fistula was 96.3%. Conclusions Using Logistic regression analysis in combination with clinical variables, the model predicing the surgical success was established. Using the ROC, the predictive efficacy of the model was evaluated to increase the positive predictive value of the operation. This model can predict the early surgical success rate of arteriovenous fistula to some extent.

       

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