摘要
目的:探讨维持性血透患者内瘘失功的危险因素并构建相关风险模型。方法:纳入2020年1月—2023年2月某院行长期规律透析的114例患者为研究对象,根据是否发生内瘘失功分为失功组(n=26)和非失功组(n=88)。收集并比较2组患者临床和实验室检查资料,通过二元Logistic回归分析明确影响内瘘失功的危险因素并构建风险模型,采用受试者工作特征曲线(ROC)评估该模型的效能。结果:本研究中内瘘失功发生率为22.81%(26/114)。内瘘失功组患者使用人造血管、透析后压迫止血时间>30 min、透析中低血压比例及低密度脂蛋白(LDL)、总胆固醇(TC)、甘油三酯(TG)水平高于非失功组,高密度脂蛋白(HDL)水平低于非失功组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,使用人造血管(OR=8.432)、透析后压迫止血>30 min(OR=6.937)、透析中低血压(OR=11.977)、LDL高水平(OR=5.882)是影响MHD患者内瘘失功的危险因素。据此构建的风险模型预测内瘘失功的AUC为0.882,敏感度和特异度分别为73.08%和89.77%。结论:使用人造血管、透析后压迫止血>30 min、透析中低血压及LDL高水平的MHD患者更易发生内瘘失功,据此构建的风险模型对预测内瘘失功具有较高的效能。
Objective:To explore the risk factors of arteriovenous internal fistula failure in patients with maintenance hemodialysis(MHD)and to construct a corresponding risk model.Methods:A total of 114 MHD patients undergoing long-term regular hemodialysis in a hospital from January 2020 to February 2023 were included and divided into a failure group(n=26)and a non-failure group(n=88).Clinical and laboratory data of the two groups were collected and compared,and the risk factors affecting the failure were identified by binary logistic regression,based on which a risk model was constructed.The receiver operating characteristic(ROC)curve was used to evaluate the model efficacy.Results:The incidence of internal fistula failure in this study was 22.81%.Compared with the non-failure group,the proportion of prosthetic blood vessels,homeostasis time after dialysis>30 minutes,intra-dialytic low blood pressure,as well as low-density lipoprotein(LDL),total cholesterol(TC)and triglycerides(TG)were significantly increased(P<0.05),whereas the high-density lipoprotein(HDL)decreased significantly(P<0.05).Multivariate logistic regression indicated that prosthetic blood vessel(OR=8.43),compression homeostasis for>30 minutes after dialysis(OR=6.94),intra-dialytic hypotension(OR=11.98)and high LDL level(OR=5.88)were risk factors for failure in MHD patients.The risk model whereupon constructed predicted internal fistula failure as AUC(0.88),sensitivity(73.08%)and specificity(89.77%),respectively.Conclusion:MHD patients with prosthetic blood vessels,compression homeostasis for>30 minutes,intra-dialytic low blood pressure and high LDL levels are more prone to the experience of internal fistula failure.The risk model constructed on this basis has high effect in predicting arteriovenous fistula failure.
作者
余晶晶
赵丽敏
余婷
段含含
YU Jingjing;ZHAO Limin;YU Ting;DUAN Hanhan(Blood Purification Center,The Tenth People's Hospital Affiliated to Tongji University,Shanghai,200072,China)
出处
《淮海医药》
CAS
2023年第5期463-466,471,共5页
Journal of Huaihai Medicine
基金
2021年上海市第十人民医院专科护理人才项目(SYZKHLRC—C19)。
关键词
透析疗法
内瘘失功
危险因素
风险模型
Dialysis therapy
Arteriovenous fistula failure
Risk factors
Risk model
