中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (12): 1022-1026.doi: 10.3969/j.issn.1671-4091.2025.12.012

• 血管通路 • 上一篇    下一篇

血液透析患者经皮腔内血管成形术后自体动静脉内瘘再狭窄影响因素的Meta分析

刘旺兴   申 微    彭雪玲    谢 萍    孙 萍    刘 凤    杨 珂    姚汝凡   

  1. 410005 长沙，1湖南省人民医院(湖南师范大学附属第一医院)血液净化中心一部
  • 收稿日期:2025-04-08 修回日期:2025-05-29 出版日期:2025-12-12 发布日期:2025-12-12
  • 通讯作者: 申微 E-mail:swan916@sina.com
  • 基金资助:
    湖南省卫生健康委科研计划项目(B202314017099)；长沙市2021年度指导性科技计划项目(kzd21061)

Meta-analysis of the influencing factors for restenosis of autologous arteriovenous fistula after percutaneous transluminal angioplasty in hemodialysis patients

LIU Wang-xing, SHEN Wei, PENG Xue-ling, XIE Ping, SUN Ping, LIU Feng, YANG Ke, YAO Ru-fan   

  1. Blood Purification Center, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha 410005, China
  • Received:2025-04-08 Revised:2025-05-29 Online:2025-12-12 Published:2025-12-12
  • Contact: 410005 长沙，1湖南省人民医院(湖南师范大学附属第一医院)血液净化中心一部 E-mail:swan916@sina.com

摘要： 目的 探讨血液透析(hemodialysis,HD)患者经皮腔内血管成形术(percutaneous transluminal angioplast,PTA)后自体动静脉内瘘(arteriovenous  fistula,AVF)再狭窄的影响因素，为早期识别和针对性干预提供参考。 方法 计算机检索中国生物医学文献数据库、中国知网、万方数据知识服务平台、Pubmed、Web of Science、Embase、The Cochrane Library中关于HD患者PTA手术后AVF再狭窄影响因素的文献，检索时限为2015年3月—2025年3月，采用Stata 18.0软件进行Meta分析。 结果 共纳入18篇文献，累计3789例患者。Meta分析结果显示：年龄(HR=1.058,95% CI:1.036～1.081,P＜0.001)、AVF使用年限(HR=0.869,95% CI:0.665～1.074,P＜0.001)、合并糖尿病(HR=1.019,95% CI:1.009～1.028,P＜0.001)、血清甲状旁腺激素水平(HR=1.042,95% CI:0.942～1.141,P＜0.001)、血清白蛋白(HR=0.744,95% CI:0.592～0.897,P＜0.001)、腹主动脉弓钙化积分(HR=1.46,95% CI:0.925～1.995,P＜0.001)、高位瘘(HR=1.836,95% CI:1.128～2.544,P＜0.001)、血管钙化(HR=2.390,95% CI:1.164～3.615,P＜0.001)、病变长度(HR=1.03,95% CI:1.001～1.060,P＜0.001)、血管通路血流速度(HR=0.983,95% CI:0.960～1.005,P＜0.001)、PTA治疗病史(HR=1.632,95%CI:0.407～2.858,P=0.009)为HD患者PTA手术后AVF再狭窄的危险因素。 结论 HD患者PTA手术后AVF再狭窄的影响因素较多，医护人员应针对该类人群存在的危险因素进行早期识别，并进行个性化的干预。

关键词: 血液透析, 经皮腔内血管成形术, 自体动静脉内瘘, 影响因素

Abstract: Objective  To explore the influencing factors for restenosis of autologous arteriovenous fistula (AVF) after percutaneous transluminal angioplasty (PTA) in hemodialysis (HD) patients, so as to provide references for early identification and targeted intervention.  Methods  Computer retrieval of the literatures about influencing factors for AVF restenosis after PTA in HD patients was conducted by search of the databases of CBM, CNKI, Wanfang Database, Pubmed, Web of Science, Embase and The Cochrane Library. The retrieval time was from March 2015 to March 2025, and the meta-analysis was carried out by using software Stata 18.0.  Results  A total of 18 articles were included, with a total of 3,789 patients. Meta-analysis results showed that age (HR=1.058, 95% CI: 1.036～1.081, P＜0.001), AVF service life (HR=0.869, 95% CI: 0.665～1.074, P＜0.001), diabetes mellitus (HR=1.019, 95% CI: 1.009～1.028, P＜0.001), serum parathyroid hormone level (HR=1.042, 95% CI: 0.942～1.141, P＜0.001), serum albumin level (HR=0.744, 95% CI: 0.592～0.897, P＜0.001), abdominal aortic arch calcification score (HR=1.46, 95% CI: 0.925～1.995, P＜0.001), higher fistula position (HR=1.836, 95% CI: 1.128～2.544, P＜0.001), vascular calcification (HR=2.390, 95% CI: 1.164～3.615, P＜0.001), lesion length (HR=1.03, 95% CI: 1.001～1.060, P＜0.001), vascular access blood flow velocity (HR=0.983, 95% CI: 0.960～1.005, P＜0.001) and PTA treatment history (HR=1.632, 95% CI: 0.407～2.858, P=0.009) were the risk factors for AVF restenosis after PTA in HD patients.  Conclusion  Many influencing factors are related to AVF restenosis after PTA in HD patients. Medical staff should identify the risk factors in this kind of population at an early stage and carry out personalized intervention.

Key words: Hemodialysis, Percutaneous transluminal angioplasty, Autologous arteriovenous fistula, Influencing factor

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