中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (03): 214-218.doi: 10.3969/j.issn.1671-4091.2024.03.013

• 血管通路 • 上一篇    下一篇

个体化预测血液透析患者动静脉内瘘手术后并发功能不良的风险列线图模型构建

贡春晨   王婷婷    马 晴    段俗言    许贤荣   

  1. 210000 南京，1江苏省人民医院肾内科
  • 收稿日期:2023-10-24 修回日期:2023-12-06 出版日期:2024-03-12 发布日期:2024-03-12
  • 通讯作者: 贡春晨 E-mail:xxr98147@163.com
  • 基金资助:
    江苏省自然科学基金(BK20191075)

Construction of a nomogram model of individualized risk prediction for postoperative arteriovenous fistula dysfunction in hemodialysis patients

GONG Chun-chen, WANG Ting-ting, MA Qing, DUAN Su-yan, XU Xian-rong   

  1. Department of Nephrology, Jiangsu Provincial People's Hospital, Nanjing 210000, China
  • Received:2023-10-24 Revised:2023-12-06 Online:2024-03-12 Published:2024-03-12
  • Contact: 210000 南京，1江苏省人民医院肾内科 E-mail:xxr98147@163.com

摘要： 目的 构建个体化预测血液透析患者自体动静脉内瘘(arteriovenous fistula,AVF)手术后并发功能不良的风险列线图模型。 方法 将2021年7月—2023年7月期间在江苏省人民医院行AVF术的126例血液透析患者作为本次研究对象，根据手术后是否并发AVF功能不良分为不良组(n=31)和良好组(n=95)。收集患者的临床资料，经多因素Logistic逐步回归分析探讨血液透析患者手术后并发AVF功能不良的影响因素；构建血液透析患者手术后并发AVF功能不良的风险列线图模型，并采用受试者工作特性(ROC)曲线评估列线图的预测价值。 结果 216例血液透析患者并发AVF功能不良的发生率为24.60%(31/126)。不良组年龄≥60岁占比、合并糖尿病占比、透析时发生低血压占比、血小板计数、LDL-C、血磷、钙磷乘积大于良好组(t/χ2=4.946、4.527、10.333、9.789、7.164、16.065、18.817，P=0.026、0.033、＜0.001、＜0.001、＜0.001、＜0.001、＜0.001)，血清白蛋白小于良好组(t=7.997，P＜0.001)。多因素Logistic逐步回归分析：显示年龄≥60岁(OR=2.061，95% CI：1.431～2.967，P＜0.001)、合并糖尿病(OR=2.776，95% CI：1.814～4.247，P＜0.001)、透析时发生低血压(OR=2.286，95% CI：1.542～3.390，P＜0.001)、血小板计数水平高(OR=2.499，95% CI：1.643～3.802，P＜0.001)、钙磷乘积高(OR=2.234，95% CI：1.528～3.268，P＜0.001)是血液透析患者手术后并发AVF功能不良的独立危险因素。建立预测血液透析患者手术后并发AVF功能不良的列线图，C-index为0.738(95% CI：0.687～0.789)。ROC曲线对血液透析患者手术后并发AVF功能不良列线图的预测价值结果显示，曲线下面积(AUC)为0.792(95% CI：0.741～0.843)，特异度为73.05%，敏感度为78.14%(Z=11.257，P＜0.001)，Hosmer-Lemeshow拟合优度检验=8.746、P=0.394。 结论 基于年龄、合并糖尿病、透析时发生低血压、血小板计数、钙磷乘积构建的列线图对血液透析患者手术后并发AVF功能不良的发生风险具有较高的预测价值。

关键词: 血液透析, 自体动静脉内瘘功能不良, 危险因素, 列线图模型

Abstract: Objective To construct a nomogram model for postoperative arteriovenous fistula (AVF) dysfunction in hemodialysis patients.  Methods  A total of 126 hemodialysis patients undergoing AVF operation in our hospital from July 2021 and July 2023 were taken as the research subjects. They were divided into dysfunction group (n=31) and normal function group (n=95) according to the postoperative AVF function. Their clinical data were collected. The influencing factors for postoperative AVF dysfunction in hemodialysis patients were investigated by logistic stepwise regression analysis. A nomogram model of  risk prediction for postoperative AVF dysfunction in hemodialysis patients was constructed, and its predictive value was evaluated using receiver operating characteristic (ROC) curve. Results  The incidence of AVF dysfunction in the 216 hemodialysis patients was 24.60% (31/126). The ratios of ≥60 years old, diabetes mellitus and hypotension during dialysis, and  the values of platelet count, LDL-C, blood phosphorus, and calcium and phosphorus product were higher in dysfunction group than in normal function group (t/χ2=4.946, 4.527, 10.333, 9.789, 7.164, 16.065, and 18.817 respectively, P=0.026, 0.033,＜0.001,＜0.001,＜0.001,＜0.001 and＜0.001 respectively), while serum albumin was lower in dysfunction group than in normal function group (t=7.997, P＜0.001). Multivariate logistic regression showed that age≥60 years old (OR=2.061, 95% CI: 1.431～2.967, P＜0.001), combined with diabetes mellitus (OR=2.776, 95% CI: 1.814～4.247, P＜0.001), hypotension during dialysis (OR=2.286, 95% CI:1.542～3.390,P＜0.001), higher platelet count (OR=2.499, 95% CI: 1.643～3.802, P＜0.001) and higher calcium and phosphorus product (OR=2.234, 95% CI:1.528～3.268, P＜0.001) were the independent risk factors for postoperative AVF dysfunction in hemodialysis patients. The C-index was 0.738 (95% CI: 0.687～0.789) for predicting postoperative AVF dysfunction in hemodialysis patients. ROC curve for the nomogram to predict postoperative AVF dysfunction in hemodialysis patients showed that the area under the curve (AUC) was 0.792 [95% CI：0.792 (0.741～0.843)], with the specificity of 73.05% and the sensitivity of 78.14% (Z=11.257, P＜0.001). Hosmer-Lemeshow goodness of fit test was 8.746 (P=0.394).  Conclusion  The nomogram based on age, combined diabetes, hypotension, platelet count, calcium and phosphorus product had a higher predictive value for the risk of postoperative AVF dysfunction in hemodialysis patients.

Key words: Hemodialysis, Arteriovenous fistula dysfunction, Risk factor, Nomogram model

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