血液透析AVF患者首次行PTA术后再狭窄的影响因素分析

Influence Factors of Restenosis after First PTA in AVF Patients with Hemodialysis

摘要

目的:探究血液透析自体动静脉内瘘(AVF)患者首次行经皮腔内血管成形术(PTA)后再狭窄的影响因素。方法:回顾性分析2021年7月—2024年7月黄石爱康医院收治的75例血液透析AVF并首次行PTA的患者,根据术后是否再狭窄分为再狭窄组(n=30)和未再狭窄组(n=45)。收集两组患者的一般资料,采用单因素及多因素Logistic回归分析血液透析AVF患者首次行PTA术后再狭窄的独立影响因素,绘制受试者工作特征(ROC)曲线分析各危险因素预测再狭窄的价值。结果:单因素分析显示,再狭窄组的狭窄直径[(2.05±0.38) mm vs (2.68±0.45) mm]和球囊直径[(4.95±1.05) mm vs (5.52±1.12) mm]均小于未再狭窄组(均P<0.05);再狭窄组狭窄部位为吻合口或近吻合口的比例(80.00% vs 46.67%)、狭窄长度[(14.85±4.05) mm vs (11.62±3.78) mm]及球囊充气时间[(44.28±8.15) s vs (34.65±7.92) s]均高于未再狭窄组(均P<0.05)。多因素Logistic回归分析显示,狭窄直径减小(OR=0.693,95%CI: 0.539, 0.890)、狭窄部位为吻合口或近吻合口(OR=2.201,95%CI: 1.117,4.336)及狭窄长度延长(OR=1.744,95%CI: 1.149,2.647)是血液透析AVF患者首次行PTA术后再狭窄的独立影响因素(均P<0.05)。ROC曲线显示,狭窄直径的曲线下面积(AUC)最高(0.770),狭窄长度次之(0.736),狭窄部位最低(0.667);联合预测的AUC是0.916,具有较高的预测价值。结论:狭窄直径减小、狭窄部位为吻合口或近吻合口及狭窄长度延长是血液透析AVF患者首次行PTA术后再狭窄的独立影响因素,且上述指标联合预测具有较高的价值。

Abstract

Objective: To investigate the influencing factors of restenosis after first percutaneous transluminal angioplasty (PTA) in autologous arteriovenous fistula (AVF) patients with hemodialysis. Methods: From July 2021 to July 2024, a total of 75 AVF patients with hemodialysis who underwent PTA for the first time in the hospital were retrospectively analyzed. According to whether there was restenosis after surgery, the patients were divided into restenosis group (n=30) and non-restenosis group (n=45). The general data of the two groups were collected. Univariate and multivariate Logistic regression analyses were used to analyze the independent influencing factors of restenosis after first PTA in AVF patients with hemodialysis. Receiver operating characteristic (ROC) curve was drawn to analyze the value of all risk factors on predicting postoperative restenosis in AVF patients with hemodialysis receiving first PTA. Results: Univariate analysis showed that the stenosis diameter[(2.05±0.38) mm vs (2.68±0.45) mm] and balloon diameter[(4.95±1.05) mm vs (5.52±1.12) mm] in restenosis group were both smaller than those in non-restenosis group (both P<0.05). While the proportion of stenosis location at or near the anastomotic stoma (80.00% vs 46.67%), stenosis length[(14.85±4.05) mm vs (11.62±3.78) mm] and balloon inflation time[(44.28±8.15) s vs (34.65±7.92) s] were higher than those in non-restenosis group (all P<0.05). Multivariate Logistic regression analysis showed that decreased stenosis diameter (OR=0.693, 95%CI: 0.539, 0.890), stenosis location at or near the anastomotic stoma (OR=2.201, 95%CI: 1.117, 4.336) and increased stenosis length (OR=1.744, 95%CI: 1.149, 2.647) were independent risk factors of restenosis after first PTA in AVF patients with hemodialysis (all P<0.05). ROC curve showed that area under the curve (AUC) of stenosis diameter was the highest (0.770), followed by stenosis length (0.736), and stenosis location was the lowest (0.667). The AUC of combined prediction was 0.916, with high predictive value. Conclusion: Decreased stenosis diameter, stenosis location at or near the anastomotic stoma, and increased stenosis length are independent risk factors of restenosis in AVF patients with hemodialysis after first PTA, and combined prediction with the above indicators has high value.

关键词

血液透析 / 自体动静脉内瘘 / 经皮腔内血管成形术 / 再狭窄

Key words

hemodialysis / autologous arteriovenous fistula (AVF) / percutaneous transluminal angioplasty (PTA) / restenosis

参考文献

[1] 谢巧明. 尿毒症血液透析患者自体动静脉内瘘成熟的影响因素[J]. 护理实践与研究, 2022, 19(5): 655-658.

[2] 国家卫生健康委能力建设和继续教育中心透析专项规范化技能竞赛标准编写工作组, 王颖. 经自体动静脉内瘘穿刺行血液透析治疗上机操作(视频演示)全国30个省市横断面调查[J]. 中国血液净化, 2025, 24(6): 518-523.

[3] Lok C E, Huber T S, Orchanian—Cheff A, et al. Arteriovenous access for hemodialysis: a review[J]. JAMA, 2024, 331(15): 1307-1317.

[4] Han M H, Zhao Q, Zhao J, et al. Risk prediction models for autogenous arteriovenous fistula failure in maintenance hemodialysis patients: a systematic review and meta—analysis[J]. World J Surg, 2024, 48(10): 2526-2542.

[5] Yu H, Chi Y Q, Wang B X. The efficacy of percutaneous transluminal angioplasty and arteriovenous fistula reconstruction for immature arteriovenous fistula[J]. BMC Nephrol, 2023, 24(1): 304.

[6] Huang C X, Yao G M, Hu R H, et al. Outcome and risk factors of restenosis post percutaneous transluminal angioplasty at juxta—anastomotic of wrist autogenous radial—cephalic arteriovenous fistulas: a retrospective cohort study[J]. Ann Vasc Surg, 2023, 93: 234-242.

[7] Xing X, Li Q, Yang Y, et al. Factors affecting the primary patency of native arteriovenous fistulas after ultrasound—guided percutaneous transluminal angioplasty[J]. Ren Fail, 2023, 45(1): 2233623.

[8] 中国血液透析血管通路超声介入治疗共识专家组. 中国血液透析血管通路超声介入治疗专家共识(2024年版)[J]. 中华肾脏病杂志, 2024, 40(11): 918-930.

[9] 上海市肾内科临床质量控制中心专家组. 慢性肾脏病早期筛查、诊断及防治指南(2022年版)[J]. 中华肾脏病杂志, 2022, 38(5): 453-464.

[10] Chen B, Tu B, Lai Q Q, et al. Patency and factors related to patency after percutaneous transluminal angioplasty for inflow arterial stenosis in native arteriovenous fistula dysfunction: a single—center retrospective study[J]. Sci Rep, 2024, 14(1): 21072.

[11] Delfiner M S, Hoffman M, White A, et al. Impact of arteriovenous fistula compression on mitral regurgitation severity[J]. Circ Heart Fail, 2023, 16(10): e010733.

[12] Wang L Q, Yang Y N, Zhao Q Q. Retrospective analysis of predictive factors for AVF dysfunction in patients undergoing MHD[J]. Medicine, 2024, 103(16): e37737.

[13] Duque J C, Tabbara M, Martinez L, et al. Dialysis arteriovenous fistula failure and angioplasty: intimal hyperplasia and other causes of access failure[J]. Am J Kidney Dis, 2017, 69(1): 147-151.

[14] Chen B, Lin R, Dai H T, et al. One—year outcomes and predictive factors for primary patency after stent placement for treatment of central venous occlusive disease in hemodialysis patients[J]. Ther Adv Chronic Dis, 2022, 13: 1-13.

[15] Kim M J, Ko H, Han S, et al. Artery—to—fistula diameter ratio as a predictor of early re—occlusion of immature right radio—cephalic arteriovenous fistula after primary PTA[J]. Diagnostics, 2022, 12(9): 2059.

[16] 张顺婷, 王思妍, 王宇飞, 等. 外周切割球囊与高压球囊在经皮腔内血管成形术治疗自体动静脉内瘘狭窄中的应用效果比较[J]. 中华医学杂志, 2025, 105(28): 2385-2390.

[17] Battistella A, Linger M, Nguyen A T, et al. Rebuilding vascular access: from the viewpoint of mechanics and materials[J]. Front Bioeng Biotechnol, 2024, 12: 1448186.

[18] 杨晨, 王珊, 林一钦. 彩色多普勒超声联合B—Flow在尿毒症血液透析患者自体动静脉内瘘功能评估中的应用价值[J]. 中国临床医学影像杂志, 2024, 35(10): 721-724.

[19] 李相杰, 郑国富, 赵霞, 等. 动静脉移植物内瘘行经皮腔内球囊血管成形术后初级通畅时间的影响因素[J]. 中华医学杂志, 2024, 104(32): 3037-3041.

[20] 李雪丹, 吴健谊, 宋志霞, 等. 维持性血液透析患者自体动静脉内瘘术后束臂功能锻炼的应用效果[J]. 巴楚医学, 2023, 6(2): 73-77.

[21] Wang Y, Huang X M, Zhang Y, et al. Comparison of ultrasound features and lesion sites in dysfunctional arteriovenous fistula[J]. Ren Fail, 2024, 46(1): 2294148.

[22] 张倩, 卢文文, 谭晋韵, 等. 冠脉钙化与血液透析患者动静脉内瘘经皮腔内血管成形术后再狭窄危险的评估[J]. 肾脏病与透析肾移植杂志, 2023, 32(1): 8-14.

[23] Kakizaki S, Kozuki A, Kijima Y, et al. Predictor analysis of 1—year restenosis after percutaneous transluminal angioplasty for femoropopliteal stenotic lesions using intravascular ultrasound[J]. Heart Vessels, 2021, 36(11): 1661-1669.

[24] Haruguchi H, Suemitsu K, Isogai N, et al. IN.PACT AV access randomized trial: Japan cohort outcomes through 12 months[J]. Ther Apher Dial, 2023, 27(4): 682-693.

[25] van Vliet L V, Zonnebeld N, Tordoir J H, et al. Guideline recommendations on minimal blood vessel diameters and arteriovenous fistula outcomes[J]. J Vasc Access, 2024, 25(5): 1584-1592.

[26] Chen M C, Weng M J, Chao L. Characterization of hemodialysis fistulas experienced abrupt thrombosis and determination of a proper follow—up protocol: a retrospective cohort study and an interventionist's perspective[J]. PLoS One, 2023, 18(3): e0282891.

[27] Woo K, Ulloa J, Allon M, et al. Establishing patient—specific criteria for selecting the optimal upper extremity vascular access procedure[J]. J Vasc Surg, 2017, 65(4): 1089-1103.

[28] 刘雨杭, 周伟, 闫建锋, 等. 高频彩色多普勒超声在终末期肾病维持性血液透析自体动静脉内瘘术后流量评估中的应用[J]. 海南医学, 2023, 34(12): 1770-1773.

[29] 游睿, 曹正江, 陈辉. 血液透析患者自体动静脉内瘘应用时机及并发症预防研究进展[J]. 中国中西医结合肾病杂志, 2024, 25(12): 1092-1093.

[30] 袁媛, 罗朋, 封雪, 等. 常规超声及三维斑点追踪成像技术对血液透析患者自体动静脉内瘘成熟的预测价值[J]. 陆军军医大学学报, 2025(11): 1243-1252.

基金资助

湖北省重点实验室开放基金项目(2024SJ123)