中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (10): 863-867.doi: 10.3969/j.issn.1671-4091.2025.10.015

• 血管通路 • 上一篇    下一篇

自体动静脉内瘘成熟不良的风险因素分析及决策树预测模型构建与验证

李文琴    刘光维   

  1. 400016 重庆，1重庆医科大学附属第一医院护理部
  • 收稿日期:2024-11-12 修回日期:2025-07-24 出版日期:2025-10-12 发布日期:2025-10-12
  • 通讯作者: 刘光维 E-mail:iwinq@163.com

Risk factor analysis of poor maturation of autologous arteriovenous endovascular fistula and construction and validation of a decision tree prediction model

LI Wen-qin, LIU Guang-we   

  1. Department of Nursing, the First Affiliated Hospital of Chongqing Medical University Chongqing 400016
  • Received:2024-11-12 Revised:2025-07-24 Online:2025-10-12 Published:2025-10-12
  • Contact: 400016 重庆，1重庆医科大学附属第一医院护理部 E-mail:iwinq@163.com

摘要： 目的  分析自体动静脉内瘘(arteriovenous fistula，AVF)成熟不良的风险因素，并基于风险因素构建决策树预测模型。 方法  回顾性抽取2023年10月─2024年10月重庆医科大学附属第一医院肾内科收治接受AVF成形手术的维持性血液透析患者作为研究对象，分析患者一般资料，分析决策树预测模型的诊断效能。 结果  648例接受AVF成形手术的患者中，AVF成熟不良患者145例，发生率为22.38%。体质量指数(body mass index，BMI)＞28 kg/m2(OR=1.863，95% CI：1.252～2.771，P=0.002)、高血压(OR=2.033，95% CI：1.362～3.035，P=0.001)、吸烟(OR=2.134，95% CI：1.432～3.181，P＜0.001)、桡动脉内径＜2 mm(OR=1.814，95% CI：1.217～2.704，P=0.003)、肱动脉血流量＜650 mL/min(OR=2.086， 95% CI：1.398～3.113，P＜0.001)、甲状旁腺激素＞65 ng/L(OR=1.708，95% CI：1.149～2.539，P=0.008)、未服用钙离子拮抗剂药物(OR=1.707，95% CI：1.145～2.547，P=0.009)是AVF成熟不良的独立危险因素。决策树模型筛选出了肱动脉血流量、BMI、吸烟、服用钙离子拮抗剂药物、甲状旁腺激素、高血压、桡动脉内径作为模型的节点，其中肱动脉血流量与AVF成熟不良最具相关性。验证决策树模型的AUC值为0.822(95%CI：0.790～0.854)。 结论  本研究构建的决策树预测模型具有较高临床实用性，可详细分析某预测变量在不同亚群中的影响，可为预测AVF成熟不良提供一定参考。

关键词: 自体动静脉内瘘, 决策树算法, 危险因素

Abstract:  Objective  To analyze the risk factors for poor maturation of autologous arteriovenous fistula (AVF) and construct a decision tree prediction model based on the risk factors.  Methods  A total of 648 maintenance hemodialysis patients undergoing AVF creation surgery in the Department of Nephrology, the First Affiliated Hospital of Chongqing Medical University from October 2023 to October 2024 were retrospectively reviewed. Their general data were analyzed. The diagnostic efficacy of the decision tree prediction model was analyzed. Statistical processing was performed using SPSS 26.0 and SPSS Modeler 18.0 software.  Result  Among the 648 patients undergoing AVF creation surgery, 145 had poor AVF maturation with an incidence rate of 22.38%. BMI ＞28 kg/m² (OR=1.863, 95% CI: 1.252～2.771, P=0.002), hypertension (OR=2.033, 95% CI: 1.362～3.035, P= 0.001), smoking (OR=2.134, 95% CI: 1.432～3.181, P<0.001), radial artery diameter <2 mm (OR=1.814, 95% CI: 1.217～2.704, P=0.003), brachial artery blood flow <650 mL/min (OR=2.086, 95% CI: 1.398～3.113, P<0.001), parathyroid hormone >65ng/L (OR=1.708, 95% CI: 1.149～2.539, P=0.008), and no calcium channel blocker medication (OR=1.707, 95% CI: 1.145～2.547, P=0.009) are independent risk factors for poor AVF maturation (P<0.05). The decision tree model selected brachial artery blood flow, BMI, smoking, calcium channel blocker medication, parathyroid hormone, hypertension, and radial artery diameter as the nodes in the model. Among these nodes, brachial artery blood flow was in the first layer, showing the strongest correlation with AVF immaturity. The AUC value for validating the decision tree model was 0.822 (95% CI: 0.790～0.854).  Conclusion  The decision tree prediction model constructed in this study has a higher clinical applicability. It can comprehensively analyze the impact of a specific predictor variable in different subgroups, offering a useful reference for predicting AVF immaturity.

Key words: Arteriovenous fistula, Decision tree algorithm, Risk factors

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