构建慢性肾功能衰竭血液透析患者发生自体动静脉内瘘栓塞的列线图模型OA
Constructing a column chart model for the occurrence of autogenous arte-riovenous fistula embolism in patients with chronic renal failure undergo-ing hemodialysis
目的 分析慢性肾功能衰竭患者在进行血液透析治疗后发生自体动静脉内瘘栓塞的危险因素,并构建相应的预测模型.方法 回顾性分析 2023 年 10 月至 2024 年 10 月于广东省人民医院赣州医院接受血液透析的 288 例慢性肾功能衰竭患者作为研究对象,按照是否发生自体动静脉内瘘栓塞分为发生组(n=52)和未发生组(n=236).统计两组患者的临床资料,包括年龄,性别,吸烟史,饮酒史,是否合并高血压、糖尿病和高脂血症,是否内瘘感染,内瘘使用时间以及血液透析后压迫时间,实验室指标包括血红蛋白、低密度脂蛋白、钙磷乘积.采用logistic回归分析患者发生自体动静脉内瘘栓塞的影响因素.结果 单因素分析显示,两组患者年龄、是否合并糖尿病和高脂血症、低密度脂蛋白、钙磷乘积以及血液透析后压迫时间比较,差异有统计学意义(P＜0.05).ROC曲线结果显示,年龄、低密度脂蛋白、钙磷乘积以及血液透析后压迫时间的AUC依次为 0.789、0.802、0.721、0.802.多因素logistic回归分析显示,年龄(β=-0.318,OR=0.728,95%CI:0.652～0.821)、合并糖尿病(β=2.301,OR=9.986,95%CI:3.145～31.705)、低密度脂蛋白(β=-4.439,OR=0.012,95%CI:0.003～0.055)、钙磷乘积(β=-0.103,OR=0.902,95%CI:0.856～0.950)以及血液透析后压迫时间(β=-0.250,OR=0.779,95%CI:0.705～0.860)均是慢性肾功能衰竭患者血液透析后发生自体动静脉内瘘栓塞的独立危险因素(P＜0.05).预测模型经过校准曲线验证,C指数为 0.797(95%CI:0.773～0.822),证明与实际观测结果吻合度较好,且决策曲线显示临床收益较为客观.结论 年龄、合并糖尿病、低密度脂蛋白、钙磷乘积以及血液透析后压迫时间均是慢性肾功能衰竭患者血液透析后发生自体动静脉内瘘栓塞的独立危险因素,且构建的列线图模型临床应用价值较高,临床可以根据影响因素进行针对性干预.
Objective Analyze the risk factors for the occurrence of autogenous arteriovenous fistula embolism in patients with chronic renal failure after hemodialysis,and constructed a corresponding prediction model.Methods A retrospective analysis was conducted on 288 patients with chronic renal failure undergoing hemodialysis at Guangdong Provincial People's Hospital Ganzhou Hospital from October 2023 to October 2024.The patients were divided into the occurrence group(n=52)and the non-occurrence group(n=236)based on whether they had autogenous arteriovenous fistula embolism.The clinical data of the two groups,including age,gender,smoking history,drinking history,whether they had hypertension,diabetes,and hyperlipidemia,whether there was fistula infection,fistula usage time,and blood dialysis post-pressure time,as well as laboratory indicators such as hemoglobin,low-density lipoprotein,and calcium-phosphorus product,were statistically analyzed.Logistic regression analysis was used to analyze the influencing factors of autogenous arteriovenous fistula embolism in patients.Results Univariate analysis showed that there were statistically significant differences between the two groups in terms of age,whether they had diabetes and hyperlipidemia,low-density lipoprotein,calcium-phosphorus product,and blood dialysis post-pressure time(P＜0.05).The ROC curve results showed that the AUC of age,low-density lipoprotein,calcium-phosphorus product,and blood dialysis post-pressure time were 0.789,0.802,0.721,and 0.802,respectively.Multivariate logistic regression analysis showed that age(β=-0.318,OR=0.728,95%CI:0.652-0.821),dia-betes(β=2.301,OR=9.986,95%CI:3.145-31.705),low-density lipoprotein(β=-4.439,OR=0.012,95%CI:0.003-0.055),calcium-phosphorus product(β=-0.103,OR=0.902,95%CI:0.856-0.950),and blood dialysis post-pressure time(β=-0.250,OR=0.779,95%CI:0.705-0.860)were all independent risk factors for self-arteriovenous fistula embolism in pa-tients with chronic renal failure after hemodialysis(P＜0.05).The prediction model was verified by the calibration curve,with a C-index of 0.797(95%CI:0.773-0.822),indicating a good agreement with the actual observation results,and the de-cision curve showed a relatively objective clinical benefit.Conclusion Age,diabetes,low-density lipoprotein,calci-um-phosphorus product,and blood dialysis post-pressure time are all independent risk factors for autogenous arteriovenous fistula embolism in patients with chronic renal failure after hemodialysis,and the constructed nomogram model has good clinical application value.Clinicians can conduct targeted interventions based on the influencing factors.
谢彦宏;温秀荣
广东省人民医院赣州医院 江西省赣州市立医院血液净化中心,江西 赣州 341000江西省赣州市人民医院肾内科,江西 赣州 341000
医药卫生
慢性肾功能衰竭血液透析动静脉内瘘栓塞列线图模型
Chronic renal failureHemodialysisArteriovenous fistula embolizationNomogram model
《中国当代医药》 2026 (4)
16-20,5
江西省卫生健康委科技计划项目(20202076).
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