中国血液净化

中国血液净化

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预测动静脉内瘘早期通畅率的简易模型

  

  1. 南昌大学第一附属医院肾内科   南昌大学研究生院医学部2009级   法国圣埃蒂安大学医学院
  • 收稿日期:2012-03-27 出版日期:2012-10-12 发布日期:2013-01-04

A simple prediction model for the early patency rate of arteriovenous fistula 

  • Received:2012-03-27 Online:2012-10-12 Published:2013-01-04
  • Contact: 陈钦开

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摘要： 【摘要】 目的 尝试建立预测动静脉内瘘早期通畅率的简易模型。 方法 选取南昌大学第一附属医院1051例终末期肾衰竭患者为研究对象，获得与动静脉内瘘手术相关的主要影响因素及其回归系数，以回归系数为基础建立风险评分(risk score)模型，创建预测评分公式，并考核其效果。 结果  logistic回归分析显示：头静脉直径(t=2.202，OR =2.085)、桡动脉直径(t =3.493，OR=1.767)、总胆固醇(t =-2.281，OR =0.708)、术前2d至手术当天上午平均舒张压(t =2.723，OR=1.057)为动静脉内瘘手术成功的主要影响因素，通过使用risk score模型计算各研究对象所得预测总分并绘制患者工作曲线(ROC)，曲线下的面积为0.707(P＜0.0001)。当预测总分切点选择为103.17时，该模型的灵敏度为69.46%，特异度为68.42%，其在一般人群中的阳性预测值和阴性预测值分别为98.0%和9%。 结论 通过使用头静脉直径、桡动脉直径、总胆固醇、术前2d至手术当天上午平均舒张压作为动静脉内瘘早期通畅率的预测因子，然后建立预测评分公式，此公式可能对动静脉内瘘手术的早期成功率有一定的预测效果。

关键词: 动静脉内瘘, 成功率预测, risk score模型, 预测评分公式

Abstract: 【Abstract】 Objective Method We recruited 1,051 end-stage renal disease patients in our hospital for this study. Their main factors and regression coefficients relating to AVF surgery were collected, to establish a risk score model based on the regression coefficient, to create a prediction score formula, and to evaluate their efficiencies. Results＜0.0001). It appears that the prediction score of 103.17 may be an acceptable cut off value, yielding a sensitivity of 69.46%, specificity of 68.42%, positive predictive value of 98%, and negative predictive value of 9% in a subject population.  Conclusions The prediction score formula, established based on cephalic vein diameter, radial artery diameter, serum total cholesterol, the average diastolic blood pressure 2 days prior to the surgery to the morning of the surgery day, may be useful for the prediction of AVF early patency rate. Logistic regression analyses demonstrate that cephalic vein diameter (t=2.202, OR=2.085), radial artery diameter (t=3.493, OR=1.767), serum total cholesterol (t=-2.281, OR=0.708), and the average diastolic blood pressure 2 days prior to the surgery to the morning of the surgery day (t=2.723, OR=1.057) are the major factors relating to the success rate of AVF. The area under ROC curve based on individual total prediction scores calculated from risk score model is 0.707 (P To establish a simple prediction model for the early patency rate of arteriovenous fistula (AVF).

Key words: Arteriovenous fistula, Prediction of success rate, Risk score model, Prediction score formula