中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (05): 414-419.doi: 10.3969/j.issn.1671-4091.2025.05.012

• 血管通路 • 上一篇    下一篇

纤维蛋白原与白蛋白比值在动静脉内瘘经皮腔内血管成形手术后再狭窄的预测价值

邓 洁   覃新芳   彭佳佳   廉 溪   谢艺婷   毕慧欣   

  1. 541001 桂林，1桂林医学院附属医院肾脏内科
  • 收稿日期:2024-06-24 修回日期:2025-02-12 出版日期:2025-05-12 发布日期:2025-05-12
  • 通讯作者: 毕慧欣 E-mail:26988436@qq.com
  • 基金资助:
    国家自然科学基金(81960679)

Predictive value of fibrinogen/albumin ratio for restenosis after percutaneous transluminal angioplasty of arteriovenous fistula

DENG Jie, QIN Xin-fang, PENG Jia-jia, LIAN Xi, XIE Yi-Ting, BI Hui-xin   

  1. Department of Nephrology, The Affiliated Hospital of Guilin Medical University, Guilin 541001, China
  • Received:2024-06-24 Revised:2025-02-12 Online:2025-05-12 Published:2025-05-12
  • Contact: 541001 桂林，1桂林医学院附属医院肾脏内科 E-mail:26988436@qq.com

摘要： 目的 探讨维持性血液透析(maintenance hemodialysis，MHD)患者纤维蛋白原与白蛋白比值(fibrinogen to albumin ratio,FAR)在自体动静脉内瘘经皮腔内血管成形术(percutaneous transluminal angioplasty，PTA)手术后再狭窄的预测价值。 方法  纳入2019年1月─2020年12月在桂林医学院附属医院肾内科首次行彩超引导下PTA治疗的MHD患者101例。根据随访期间是否发生PTA手术后再狭窄，分为再狭窄组和通畅组。对比2组患者的一般资料，绘制ROC曲线，评估FAR对PTA手术后再狭窄的预测价值。通过ROC曲线分析确定FAR的最佳截断值，将患者分为低FAR水平组和高FAR水平组。采用Kaplan-Meier曲线分析2组患者的内瘘通畅率，采用COX回归比例风险模型探讨影响MHD患者PTA手术后再狭窄的独立危险因素。 结果 多因素COX回归分析显示：高水平FAR(HR =2.455，95% CI:1.299～4.639，P=0.006)是MHD患者动静脉内瘘首次PTA手术后再狭窄的独立危险因素。FAR预测PTA手术后动静脉内瘘再狭窄的AUC为0.735(95% CI:0.638～0.818，P＜0.001)。Kaplan-Meier曲线生存分析显示，高FAR水平组患者PTA手术后通畅率低于低FAR水平组(Log Rank检验χ2=15.470，P＜0.001)。 结论 FAR水平的升高是PTA手术后再狭窄的独立危险因素。FAR可作为预测MHD患者首次PTA手术后再狭窄的生物标志物，为早期防治PTA手术后再狭窄提供临床价值。

关键词: 经皮腔内血管成形术, 再狭窄, 纤维蛋白原与白蛋白比值

Abstract: Objective To explore the predictive value of fibrinogen to albumin ratio (FAR) for restenosis after percutaneous transluminal angioplasty (PTA) of the autologous arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients.  Methods A total of 101 MHD patients undergoing color Doppler ultrasound-guided PTA for the first time at the Department of Nephrology, the Affiliated Hospital of Guilin Medical University from January 2019 to December 2020 were included in this study. According to the presence or absence of restenosis after PTA in the follow-up period, they were divided into restenosis group and patency group. Clinical data were compared between the two groups. Receiver operating characteristic (ROC) curve was made to evaluate the predictive value of FAR for restenosis after PTA. The optimal cut-off value of FAR was determined by ROC curve analysis. The patients were then divided into low FAR group and high FAR group. Patency rate of the AVF in the two groups was analyzed by Kaplan-Meier curve. Cox proportional hazards regression model was used to explore the independent risk factors affecting restenosis after PTA.  Results  ①Multivariate Cox regression analysis showed that higher FAR (HR=2.455, 95% CI:1.299～4.639, P=0.006) was an independent risk factor for restenosis of the AVF after first PTA. ② The area under the curve (AUC) of FAR for predicting restenosis of the AVF after PTA was 0.735 (P<0.001, 95% CI:0.638～0.818). ③ Kaplan-Meier curve survival analysis showed that the patency rate after PTA was significantly lower in high FAR group than in low FAR group (log rank test, χ²=15.470, P<0.001).  Conclusions   ①Higher FAR is an independent risk factor for restenosis after PTA. ②FAR can be used as a biomarker to predict restenosis after the first PTA, useful for early prevention and treatment of restenosis after PTA.

Key words: Percutaneous transluminal angioplasty, Restenosis, Fibrinogen to albumin ratio

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