维持性血液透析患者动静脉内瘘狭窄预测模型的构建
Journal: Basic Medical Theory Research DOI: 10.12238/bmtr.v7i5.16532
Abstract
目的：构建维持性血液透析(maintenance hemodialysis,MHD)患者自体动静脉内瘘(autologous arteriovenous fistula,AVF)狭窄的预测模型,为临床提供早期识别高风险患者的工具。方法：回顾性纳入2013年1月至2021年9月在义乌天祥东方医院及东阳市人民医院实施AVF成形术的142例透析患者。通过单因素与多因素Cox回归分析,筛选影响AVF狭窄的独立危险因素,构建Nomogram预测模型,并评估其准确性与一致性。结果：使用阿司匹林、未使用呋塞米、未使用铁剂、高血肌酐水平、低尿素清除率(urea reduction ratio,URR)、低泵血流量及尖针穿刺为AVF狭窄的独立危险因素。基于上述变量构建的Nomogram模型,校准曲线与标准曲线拟合良好,具有良好的预测性能与临床实用性。结论：本研究构建了一个简便可视化的AVF狭窄预测模型,可有效预测血透患者内瘘狭窄风险,辅助医护人员早期干预与精准管理。
Keywords
维持性血液透析；内瘘狭窄；Cox回归；Nomogram预测模型
Funding
金华市科技计划项目(2023-4-271)。
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[4] Perl J, Karaboyas A, Morgenstern H, et al. Association between changes in quality of life and mortality in hemod ialysis patients: results from the DOPPS[J].Nephrol Dial Trans plant,2016:gfw233.
[5] Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access:2019 Update[J].American Journ al of Kidney Diseases,2020,75(4):S1-S164.
[6] Ranganathan P,Deo V,Pramesh CS.Time-to-event analysis [J].Perspectives in Clinical Research,2025,16(2):102-105.
[7] Kumar Js,Sajeev Kumar K,Arun Thomas E,et al.Prediction model for successful radiocephalic arteriovenous fistula crea tion in patients with diabetic nephropathy[J]. Saudi J Kidney Dis Transpl,2019,30(5):1058.
[8] Wongmahisorn Y.Development and validation of a clini cal score to predict 1-year survival of arteriovenous fistula access:a diagnostic study[J].Ann Surg Treat Res,2020,98(1):44.
[9] 张莹.血液透析动静脉内瘘功能的影响因素及预测模型的建立[J].中华肾脏病杂志,2021,37(6):486-491.
[10] 周洁.2019版KDOQI血管通路临床实践指南解读[J].中华肾脏病杂志,2020,36(5):375-378.
[11] Chang TI,Chen CH, Hsieh HL,et al.Effects of cardiovasc ular medications on primary patency of hemodialysis arteriov enous fistula[J].Sci Rep,2020,10(1):12135.
[12] 中华医学会肾脏病学分会,中关村肾病血液净化创新联盟.《中国透析患者慢性心力衰竭管理指南》[J].中华肾脏病杂志,2022,38(5):465-496.
[13] Rosati A, Conti P, Berto P, et al. Efficacy, Safety and Pharmacoeconomic Analysis of Intravenous Ferric Carboxymalt ose in Anemic Hemodialysis Patients Unresponsive to Ferric Gluconate Treatment: A Multicenter Retrospective Study[J]. JCM,2022,11(18):5284.
[14] Covic A, Mircescu G.The safety and efficacy of intrav enous ferric carboxymaltose in anaemic patients undergoing haemodialysis: a multi-centre, open-label, clinical study[J]. Nephrology Dialysis Transplantation,2010,25(8):2722-2730.
[15] Steiner K.Pathophysiology of stenosis within AV fist ulas and mechanisms of PTA. Endovascular Today[J]. Endovascu lar Today,2016,15(6)[EB/OL].(2025-10-24).https://evtoday.com/ articles/2016-june/pathophysiology-of-stenosis-within-av-fistulas-and-mechanisms-of-pta.
[16] Aitken E, Jackson A, Kong C,et al.Renal function, urae mia and early arteriovenous fistula failure[J]. BMC Nephrol, 2014,15(1):179.
[17] Polkinghorne KR,Lau KKP, Saunder A,et al. Does mont hly native arteriovenous fistula blood-flow surveillance dete ct significant stenosis—a randomized controlled trial[J].Ne phrology Dialysis Transplantation,2006,21(9):2498-2506.
[18] Brahmbhatt A,Remuzzi A,Franzoni M,et al.The molecul ar mechanisms of hemodialysis vascular access failure[J]. Kidn ey International,2016,89(2):303-316.
[19] Soliveri L,Bozzetto M,Brambilla P,et al. Hemodynamics in AVF over time: A protective role of vascular remodeling tow ard flow stabilization[J].Int J Artif Organs,2023,46(10-11): 547-554.
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