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Article(id=1322210943593988483, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210896617783335, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202409152, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1727452800000, receivedDateStr=2024-09-28, revisedDate=1736956800000, revisedDateStr=2025-01-16, acceptedDate=null, acceptedDateStr=null, onlineDate=1793169254444, onlineDateStr=2026-10-28, pubDate=1745942400000, pubDateStr=2025-04-30, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793169254444, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793169254444, creator=13701087609, updateTime=1793169254444, updator=13701087609, issue=Issue{id=1322210896617783335, tenantId=1146029695717560320, journalId=1319373162502258839, year='2025', volume='47', issue='8', pageStart='749', pageEnd='892', issueExtLink='null', onlineDate='null', pubDate='1745942400000', pubDateStr='2025-04-30', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793169243243, creator='13701087609', updateTime=1793325231503, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322865158855184775, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210896617783335, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322865158855184776, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210896617783335, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=870, endPage=875, ext={EN=ArticleExt(id=1322210944093110660, articleId=1322210943593988483, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Predictive value of preoperative ultrasound for restenosis of arteriovenous fistula after percutaneous transluminal angioplasty: a report of 225 cases, columnId=1320435174995772212, journalTitle=Journal of Army Medical University, columnName=Clinical Medicine, runingTitle=null, highlight=null, articleAbstract=
Objective‍

To explore the value of preoperative ultrasound examination in the prediction of restenosis of arteriovenous fistula (AVF) after percutaneous transluminal angioplasty (PTA) in hemodialysis patients.

Methods‍

A case-control trial was conducted on 225 hemodialysis patients who undergoing PTA due to AVF in our hospital January 2023 to May 2024. After 3 months of follow-up, they were divided into a patency group (n=204) and a restenosis group (n=21) according to the occurrence of postoperative restenosis. The preoperative clinical data and ultrasound parameters were compared between the groups. Binary logistic regression analysis was used to identify the independent factors for AVF restenosis after PTA. Receiver operating characteristic (ROC) curve was drawn to evaluate the value of preoperative stenosis length in the prediction of the restenosis after PTA.

Results‍

There were significant differences in preoperative internal diameter at the site of stenosis, stenosis length, stenosis number, intimal thickness, and brachial artery flow between the 2 groups (P<0.05). Preoperative stenosis length (OR=1.856, 95%CI: 1.350~2.552, P<0.001) was an independent factor of AVF restenosis in hemodialysis patients after PTA. ROC curve analysis showed that the area under the curve of preoperative stenosis length in predicting restenosis after PTA was 0.868 (95%CI: 0.784~0.953, P<0.001), with a sensibility and specificity of 85.7% and 80.4%, respectively.

Conclusion‍

Preoperative stenosis length may be an independent factor for AVF restenosis after PTA in hemodialysis patients.

, authors=Qipei SHU1, Jun ZHANG1, Na YIN2, Jun ZHANG2, Lin SHI1, Ling YAN1, Yanli GUO1, authorsList=Qipei SHU, Jun ZHANG, Na YIN, Jun ZHANG, Lin SHI, Ling YAN, Yanli GUO, authorCompany=null, correspAuthors=Yanli GUO, authorNote=null, correspAuthorsNote=null, copyrightStatement=© 2025 Journal of Army Medical University, copyrightOwner=Editorial Office of Journal of Army Medical University, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322210945758249353, articleId=1322210943593988483, tenantId=1146029695717560320, journalId=1319373162502258839, language=CN, title=术前超声预测动静脉内瘘狭窄经皮腔内血管成形术后再狭窄的价值, columnId=1322185541475488183, journalTitle=陆军军医大学学报, columnName=临床医学, runingTitle=null, highlight=null, articleAbstract=

‍

目的

探讨术前超声对自体动静脉内瘘（arteriovenous fistula，AVF）狭窄行经皮腔内血管成形术（percutaneous transluminal angioplasty，PTA）术后再狭窄的预测价值。

方法

采用病例对照研究的方法，收集2023年1月至2024年5月陆军军医大学第一附属医院肾科、超声科225例接受PTA的AVF狭窄患者的临床及超声资料，根据术后3个月内AVF是否再狭窄分为通畅组（n=204）与再狭窄组（n=21）。对2组患者术前临床资料及超声参数进行组间比较，经多因素二元Logistic回归分析预测AVF狭窄行PTA术后再狭窄的相关因素；绘制受试者工作特征曲线（ROC），评估术前AVF血管狭窄长度预测AVF狭窄行PTA术后再狭窄的价值。

结果

2组术前AVF血管狭窄处内径、狭窄长度、狭窄数量、内膜厚度、肱动脉流量比较差异均有统计学意义（P<0.05）。术前AVF血管狭窄长度（P<0.001，OR=1.856，95%CI：1.350~2.552）是预测AVF狭窄行PTA术后再狭窄的独立相关因素。术前AVF血管狭窄长度预测AVF狭窄行PTA术后再狭窄的曲线下面积（AUC）为0.868（95%CI：0.784~0.953，P<0.001），灵敏度为85.7%，特异度为80.4%。

结论

术前AVF血管狭窄长度可能是预测AVF狭窄行PTA术后再狭窄的独立相关因素。

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‍郭燕丽，E-mail：
GUO Yanli，E-mail：
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Postgrad Med J，2007，83（982）：547-551., articleTitle=Comparison of classical and non-classical cardiovascular risk factors influencing the patency of native arteriovenous fistulas after percutaneous transluminal angioplasty therapy among haemodialysis patients, refAbstract=null), Reference(id=1322210954562093533, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, doi=10.1016/j.jvs.2015.07.086, pmid=null, pmcid=null, year=2016, volume=63, issue=1, pageStart=163, pageEnd=170.e6, url=null, language=null, rfNumber=20, rfOrder=24, authorNames=FARBER A, IMREY P B, HUBER T S, journalName=J Vasc Surg, refType=null, unstructuredReference=FARBER A，IMREY P B，HUBER T S，et al. Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study［J］. J Vasc Surg，2016，63（1）：163-170.e6., articleTitle=Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322210947754738058, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, xref=1, ext=[AuthorCompanyExt(id=1322210947763126667, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, companyId=1322210947754738058, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Ultrasonography), AuthorCompanyExt(id=1322210947767320972, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, companyId=1322210947754738058, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1陆军军医大学（第三军医大学）第一附属医院：超声科，重庆)]), AuthorCompany(id=1322210947821846925, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, xref=2, ext=[AuthorCompanyExt(id=1322210947830235534, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, companyId=1322210947821846925, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Nephrology，First Affiliated Hospital，Army Medical University （Third Military Medical University），Chongqing，China), AuthorCompanyExt(id=1322210947834429839, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, companyId=1322210947821846925, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2陆军军医大学（第三军医大学）第一附属医院：肾科，重庆)])], figs=[ArticleFig(id=1322210950300680637, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, language=EN, label=null, caption=null, figureFileSmall=JJJW5zyHWlQf4JcvxeqDZQ==, figureFileBig=ijhSDT66mjNRyKFBSvZucQ==, tableContent=null), ArticleFig(id=1322210951898710462, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, language=CN, label=图1, caption=AVF狭窄的超声表现

A：通畅组术前AVF狭窄的超声表现；B：再狭窄组术前AVF狭窄的超声表现； 箭头：狭窄段血管

, figureFileSmall=JJJW5zyHWlQf4JcvxeqDZQ==, figureFileBig=ijhSDT66mjNRyKFBSvZucQ==, tableContent=null), ArticleFig(id=1322210952112619967, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, language=EN, label=null, caption=null, figureFileSmall=bMbo3ZxcnU3NxPF5xB0v6w==, figureFileBig=m1qRCLOXfd6QbwcCOeOiUw==, tableContent=null), ArticleFig(id=1322210952175534528, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, language=CN, label=图2, caption=预测AVF狭窄行PTA术后3个月内再狭窄的ROC曲线, figureFileSmall=bMbo3ZxcnU3NxPF5xB0v6w==, figureFileBig=m1qRCLOXfd6QbwcCOeOiUw==, tableContent=null), ArticleFig(id=1322210952242643393, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
指标通畅组（n=204）再狭窄组（n=21）t/χ2/zP
年龄/岁56.8±12.561.0±12.1-1.5040.134
性别0.0180.893
男94（46.08）10（47.62）
女110（53.92）11（52.38）
吸烟史0.508a0.476
有31（15.20）5（23.81）
无173（84.80）16（76.19）
饮酒史0.223a0.637
有26（12.75）4（19.05）
无178（87.25）17（80.95）
吻合方式0.079a0.778
端侧193（94.61）19（90.48）
端端11（5.39）2（9.52）
吻合部位0.000a1
左前臂168（82.35）17（80.95）
右前臂36（17.65）4（19.05）
原发病因0.6050.437
糖尿病肾病52（25.49）7（33.33）
非糖尿病肾病152（74.51）14（66.67）
狭窄处内径/mm1.20（0.90，1.40）0.90（0.80，1.05）3.478<0.001
狭窄长度/cm2.60（1.70，3.80）5.20（4.30，8.75）-5.553<0.001
狭窄数量11.545<0.001
单个118（57.84）4（19.05）
多个86（42.16）17（80.95）
内膜厚度/mm1.30（1.10，1.60）1.60（1.35，2.00）-2.8360.005
钙化0.0250.874
有55（26.96）6（28.57）
无149（73.04）15（71.43）
瘤样扩张0.015a0.903
有11（5.39）1（4.76）
无193（94.61）20（95.24）
肱动脉流量/（mL/min）274.50（207.25，381.75）178.0（95.50，208.00）3.815<0.001
), ArticleFig(id=1322210952339112386, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, language=CN, label=表1, caption=

2组临床资料和超声参数比较 ［x¯±s，例（%），M（Q1，Q3）］

, figureFileSmall=null, figureFileBig=null, tableContent=
指标通畅组（n=204）再狭窄组（n=21）t/χ2/zP
年龄/岁56.8±12.561.0±12.1-1.5040.134
性别0.0180.893
男94（46.08）10（47.62）
女110（53.92）11（52.38）
吸烟史0.508a0.476
有31（15.20）5（23.81）
无173（84.80）16（76.19）
饮酒史0.223a0.637
有26（12.75）4（19.05）
无178（87.25）17（80.95）
吻合方式0.079a0.778
端侧193（94.61）19（90.48）
端端11（5.39）2（9.52）
吻合部位0.000a1
左前臂168（82.35）17（80.95）
右前臂36（17.65）4（19.05）
原发病因0.6050.437
糖尿病肾病52（25.49）7（33.33）
非糖尿病肾病152（74.51）14（66.67）
狭窄处内径/mm1.20（0.90，1.40）0.90（0.80，1.05）3.478<0.001
狭窄长度/cm2.60（1.70，3.80）5.20（4.30，8.75）-5.553<0.001
狭窄数量11.545<0.001
单个118（57.84）4（19.05）
多个86（42.16）17（80.95）
内膜厚度/mm1.30（1.10，1.60）1.60（1.35，2.00）-2.8360.005
钙化0.0250.874
有55（26.96）6（28.57）
无149（73.04）15（71.43）
瘤样扩张0.015a0.903
有11（5.39）1（4.76）
无193（94.61）20（95.24）
肱动脉流量/（mL/min）274.50（207.25，381.75）178.0（95.50，208.00）3.815<0.001
), ArticleFig(id=1322210952414609859, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
自变量回归系数标准误WaldPOR95%CI
狭窄处内径-0.7451.0430.5100.4750.4750.061~3.670
狭窄长度0.6180.16214.501<0.0011.8561.350~2.552
狭窄数量0.9670.7031.8920.1692.6300.663~10.435
内膜厚度0.8050.6841.3840.2392.2360.585~8.542
肱动脉流量-0.0040.0032.3410.1260.9960.990~1.001
), ArticleFig(id=1322210952498495940, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210943593988483, language=CN, label=表2, caption=

预测AVF狭窄行PTA术后再狭窄的多因素二元Logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量回归系数标准误WaldPOR95%CI
狭窄处内径-0.7451.0430.5100.4750.4750.061~3.670
狭窄长度0.6180.16214.501<0.0011.8561.350~2.552
狭窄数量0.9670.7031.8920.1692.6300.663~10.435
内膜厚度0.8050.6841.3840.2392.2360.585~8.542
肱动脉流量-0.0040.0032.3410.1260.9960.990~1.001
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术前超声预测动静脉内瘘狭窄经皮腔内血管成形术后再狭窄的价值
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舒启沛 1 , 张君 1 , 尹娜 2 , 张军 2 , 史琳 1 , 鄢玲 1 , 郭燕丽 1
陆军军医大学学报 | 临床医学 2025,47(8): 870-875
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陆军军医大学学报 |临床医学 2025 , 47 (8) : 870 -875
术前超声预测动静脉内瘘狭窄经皮腔内血管成形术后再狭窄的价值
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舒启沛1, 张君1, 尹娜2, 张军2, 史琳1, 鄢玲1, 郭燕丽1
作者信息
  • 1陆军军医大学（第三军医大学）第一附属医院：超声科，重庆
  • 2陆军军医大学（第三军医大学）第一附属医院：肾科，重庆
通讯作者:
‍郭燕丽，E-mail：
GUO Yanli，E-mail：
Predictive value of preoperative ultrasound for restenosis of arteriovenous fistula after percutaneous transluminal angioplasty: a report of 225 cases
Qipei SHU1, Jun ZHANG1, Na YIN2, Jun ZHANG2, Lin SHI1, Ling YAN1, Yanli GUO1
Affiliations
  • 1Department of Ultrasonography
  • 2Department of Nephrology，First Affiliated Hospital，Army Medical University （Third Military Medical University），Chongqing，China
出版时间: 2025-04-30 doi: 10.16016/j.2097-0927.202409152
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摘要
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‍

目的

探讨术前超声对自体动静脉内瘘（arteriovenous fistula，AVF）狭窄行经皮腔内血管成形术（percutaneous transluminal angioplasty，PTA）术后再狭窄的预测价值。

方法

采用病例对照研究的方法，收集2023年1月至2024年5月陆军军医大学第一附属医院肾科、超声科225例接受PTA的AVF狭窄患者的临床及超声资料，根据术后3个月内AVF是否再狭窄分为通畅组（n=204）与再狭窄组（n=21）。对2组患者术前临床资料及超声参数进行组间比较，经多因素二元Logistic回归分析预测AVF狭窄行PTA术后再狭窄的相关因素；绘制受试者工作特征曲线（ROC），评估术前AVF血管狭窄长度预测AVF狭窄行PTA术后再狭窄的价值。

结果

2组术前AVF血管狭窄处内径、狭窄长度、狭窄数量、内膜厚度、肱动脉流量比较差异均有统计学意义（P<0.05）。术前AVF血管狭窄长度（P<0.001，OR=1.856，95%CI：1.350~2.552）是预测AVF狭窄行PTA术后再狭窄的独立相关因素。术前AVF血管狭窄长度预测AVF狭窄行PTA术后再狭窄的曲线下面积（AUC）为0.868（95%CI：0.784~0.953，P<0.001），灵敏度为85.7%，特异度为80.4%。

结论

术前AVF血管狭窄长度可能是预测AVF狭窄行PTA术后再狭窄的独立相关因素。

‍超声  /  狭窄长度  /  动静脉内瘘  /  经皮腔内血管成形术  /  再狭窄
Objective‍

To explore the value of preoperative ultrasound examination in the prediction of restenosis of arteriovenous fistula (AVF) after percutaneous transluminal angioplasty (PTA) in hemodialysis patients.

Methods‍

A case-control trial was conducted on 225 hemodialysis patients who undergoing PTA due to AVF in our hospital January 2023 to May 2024. After 3 months of follow-up, they were divided into a patency group (n=204) and a restenosis group (n=21) according to the occurrence of postoperative restenosis. The preoperative clinical data and ultrasound parameters were compared between the groups. Binary logistic regression analysis was used to identify the independent factors for AVF restenosis after PTA. Receiver operating characteristic (ROC) curve was drawn to evaluate the value of preoperative stenosis length in the prediction of the restenosis after PTA.

Results‍

There were significant differences in preoperative internal diameter at the site of stenosis, stenosis length, stenosis number, intimal thickness, and brachial artery flow between the 2 groups (P<0.05). Preoperative stenosis length (OR=1.856, 95%CI: 1.350~2.552, P<0.001) was an independent factor of AVF restenosis in hemodialysis patients after PTA. ROC curve analysis showed that the area under the curve of preoperative stenosis length in predicting restenosis after PTA was 0.868 (95%CI: 0.784~0.953, P<0.001), with a sensibility and specificity of 85.7% and 80.4%, respectively.

Conclusion‍

Preoperative stenosis length may be an independent factor for AVF restenosis after PTA in hemodialysis patients.

‍ ‍ultrasound  /  length of stenosis  /  arteriovenous fistula  /  percutaneous transluminal angioplasty  /  restenosis
舒启沛, 张君, 尹娜, 张军, 史琳, 鄢玲, 郭燕丽. 术前超声预测动静脉内瘘狭窄经皮腔内血管成形术后再狭窄的价值. 陆军军医大学学报, 2025 , 47 (8) : 870 -875 . DOI: 10.16016/j.2097-0927.202409152
Qipei SHU, Jun ZHANG, Na YIN, Jun ZHANG, Lin SHI, Ling YAN, Yanli GUO. Predictive value of preoperative ultrasound for restenosis of arteriovenous fistula after percutaneous transluminal angioplasty: a report of 225 cases[J]. Journal of Army Medical University, 2025 , 47 (8) : 870 -875 . DOI: 10.16016/j.2097-0927.202409152
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动静脉内瘘（arteriovenous fistula，AVF）为血液透析患者的生命线，自体AVF具有存活率高、感染风险低的优势。AVF失功严重影响患者透析的充分性。AVF狭窄和血栓形成是造成AVF失功的主要原因，而血栓主要为狭窄所致［1］。超声引导下经皮腔内血管成形术（percutaneous transluminal angioplasty，PTA）是维护血管通路的主要治疗措施，AVF狭窄行PTA术后常常发生再狭窄，患者需要继续行PTA维护血管通路。如果AVF行PTA术后血管通路短期内发生再狭窄，严重影响患者生存质量及预后，更有甚者在情况允许下需要行支架或外科手术处理［2］。所以术前预测AVF狭窄行PTA术后短期内是否再狭窄，对临床制定手术方案以及对患者术后疗效评估至关重要。本研究旨在探讨术前超声对AVF狭窄行PTA术后再狭窄的预测价值。
1　资料与方法
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1.1　研究对象
采用病例对照研究的方法，收集2023年1月至2024年5月陆军军医大学第一附属医院肾科、超声科225例AVF狭窄接受PTA的血液透析患者为研究对象。纳入标准：①年龄18~90岁；②自体AVF血液透析患者；③已行PTA且术前行超声检查。排除标准：①AVF单一回流静脉头静脉弓狭窄；②合并恶性肿瘤；③重要脏器严重功能障碍；④妊娠或哺乳期女性。本研究经陆军军医大学第一附属医院伦理委员会审批［（B）KY2024329］。
1.2　仪器与方法
1.2.1　超声检查
应用迈瑞M9彩色多普勒超声诊断仪，线阵探头（频率4~12 MHz），PTA术前由同一名工作5年以上的医师行超声检查。充分暴露AVF上肢，测量AVF血管狭窄处内径、狭窄长度、内膜厚度、肱动脉流量，测量3次，取均值。若有多个狭窄，记录狭窄数量，狭窄长度为总狭窄长度，狭窄处内径选取最窄处测量，内膜厚度为最厚处测量。记录有无钙化、瘤样扩张。瘤样扩张为瘤样扩张区域内径≥2 cm或超过相邻正常血管内径3倍以上［3］。
1.2.2　手术方法
由我院肾科同一名工作10年以上的医师完成，患者平卧位，前臂外旋外展。常规消毒铺单。选择合适入路，置入导管鞘，沿导管鞘送入超滑导丝反复探查并通过狭窄段。根据狭窄病变周围血管直径选择合适大小的球囊。应用超滑导丝将球囊置于狭窄处，利用压力泵缓慢均匀加压，使球囊扩张，直至球囊切记完全消失。
1.2.3　AVF再狭窄的判定及分组［2］
AVF再狭窄的判定：AVF狭窄行PTA术后3个月内AVF血管狭窄率大于周围正常血管管径的50%且透析血流量<200 mL/min或者超声测量肱动脉流量<500 mL/min。根据PTA术后3个月内是否再狭窄分为通畅组（n=204）和再狭窄组（n=21）。
1.3　统计学方法
采用SPSS 29.0统计学软件。符合正态分布的计量资料采用x¯±s表示，组间比较采用t检验；不符合正态分布的连续性变量采用M（Q1，Q3）表示，组间比较采用Mann Whitney U检验。计数资料以例（%）表示，采用χ2检验。采用多因素二元Logistic回归分析AVF狭窄行PTA术后再狭窄的相关因素，绘制受试者工作特征曲线（ROC）评估AVF血管狭窄长度预测AVF狭窄行PTA术后再狭窄的价值。P<0.05表示差异具有统计学意义。
2　结果
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2.1　2组临床资料和超声参数比较
2组年龄、性别、吸烟史、饮酒史、吻合方式、吻合部位、原发病因、钙化、瘤样扩张比较差异均无统计学意义。2组术前AVF血管狭窄处内径、狭窄长度、狭窄数量、内膜厚度、肱动脉流量比较差异均有统计学意义（P<0.05，表1）。通畅组血管多为短段狭窄，内膜增生不严重，狭窄数量较少。再狭窄组血管多为长段狭窄，内膜增生严重，狭窄数量较多。见图1。
2.2　多因素二元Logistic回归分析
以AVF狭窄行PTA术后是否再狭窄为因变量（0=通畅组，1=再狭窄组），以术前血管狭窄处内径、狭窄长度、狭窄数量、内膜厚度、肱动脉流量为协变量（0=狭窄数量为单个，1=狭窄数量为多个；狭窄处内径、狭窄长度、内膜厚度、肱动脉流量均为连续变量），进行多因素二元Logistic回归分析，结果显示术前AVF血管狭窄长度是预测AVF狭窄行PTA术后再狭窄的独立相关因素（OR>1，P<0.05，表2）。
2.3　ROC曲线分析
术前AVF血管狭窄长度最佳截断值为4.08 cm，预测AVF狭窄行PTA术后再狭窄的曲线下面积（AUC）为0.868（95%CI：0.784~0.953，P<0.001），灵敏度为85.7%，特异度为80.4%，见图2。
3　讨论
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AVF狭窄严重影响患者透析的充分性、生活质量及寿命。以往AVF狭窄后临床通常在狭窄近心端正常血管处重新建立AVF。近年来PTA处理AVF狭窄具有良好的治疗效果［4-5］。对于AVF狭窄病变，虽然重新建立AVF的通畅率较PTA高，但重建后也存在一定问题，如吻合口出血、感染、穿刺血管资源减少等，PTA治疗AVF狭窄具有有效、安全、微创等优点，而且还能保护穿刺血管资源［6-7］。目前PTA已成为处理AVF狭窄病变的金标准［8］。
3.1　超声参数对再狭窄的预测
AVF内膜增生是AVF狭窄的主要原因［9］，由于AVF血管内膜纤维增生异常、炎性细胞浸润增殖，进而使AVF内膜增生［10］。CHEN等［11］认为内膜增生是AVF行PTA手术后1期通畅率的危险因素。本研究发现术前内膜厚度不是AVF狭窄行PTA术后再狭窄的独立相关因素。这可能由于PTA术中将部分容易夹取的增生内膜用夹子夹掉，使术后通畅率更高。引起血管狭窄的因素除了血管内膜异常增生，血管的钙化也是一个重要因素。而血管钙化是否与AVF的通畅率具有相关性，目前尚无统一意见。AVF长期穿刺或狭窄会导致AVF发生瘤样扩张，我们认为瘤样扩张的AVF血管扩张性较好，狭窄段血管PTA术后也不易再狭窄。术前AVF血管狭窄处内径与肱动脉流量主要是对AVF功能的评估，研究发现PTA术后肱动脉流量对再狭窄具有预测价值［12］。
AVF狭窄长度越长，PTA术后再狭窄的风险越高［13］。詹申等［14］研究发现AVF血管狭窄长度<36 mm的患者行外周切割球囊治疗后12个月内AVF初级通畅率显著高于狭窄长度≥36 mm的患者。ROMANN等［15］研究发现AVF狭窄患者首次PTA术前血管狭窄长度＞2 cm增加了再狭窄的风险。本研究发现术前AVF血管狭窄长度能较好地预测AVF狭窄行PTA术后是否再狭窄。AVF血管狭窄病变越长，PTA所处理的血管越长，血管受损的内膜范围就越大，更容易引起血管内膜增生，进而引起血管再狭窄［16］。对于长段狭窄其血管内膜增生不严重，术中可以选择更大的球囊，使术后血管通畅率更高。对于长段狭窄其血管内膜增生严重，可以考虑使用支架处理或改为外科手术。姚国明等［17］研究发现狭窄数量可预测PTA手术后1期辅助通畅率丢失，并认为狭窄数量与狭窄长度呈正相关。本研究狭窄数量不是AVF狭窄行PTA术后再狭窄的独立相关因素，这主要由于狭窄长度能更好地预测再狭窄。
3.2　临床指标对再狭窄的预测
年龄、糖尿病、吸烟、性别等也可能对AVF狭窄行PTA术后再狭窄进行预测，HEYE等［18］认为年龄、糖尿病是AVF功能障碍行PTA术后6个月功能障碍复发的相关因素。由于糖尿病患者血管条件差且容易钙化，少部分AVF吻合口附近静脉若形成大量大片状钙化或长段动脉纤细且钙化，PTA术后短期内易再狭窄。而大部分糖尿病患者血管PTA术后不易3个月内再狭窄。LIU等［19］认为当前吸烟可提高血液透析患者行PTA术后的通畅性，并认为当前吸烟可防止AVF血管内膜增生。FARBER等［20］认为女性患者AVF通畅时间较男性患者短，性别可能是AVF狭窄行PTA术后再狭窄的相关因素，但短期内无统计学差异。
3.3　本研究的创新性和局限性
本研究分析了术前血管狭窄长度在预测AVF狭窄行PTA术后3个月内再狭窄的价值，初步确定了狭窄长度的截断值，对临床起到提示作用。术前超声对临床制定手术方案以及对患者术后疗效预测起到决定性作用。但本研究也存在一定局限性：①本研究为单中心、回顾性研究，难以完全避免临床数据的偏倚。②由于近年来PTA技术的成熟，再狭窄的病例数较少，统计学上可能存在一定的偏差，有待于大样本量进一步验证。③对长段狭窄的测量，由于一个超声探头无法测量，测值可能存在略微的误差。④本研究仅分析了3个月再狭窄，未对6、9、12个月等多时间点进行分析，有待进一步研究。
综上所述，本研究提示，AVF血管狭窄长度为4.08 cm可能为预测AVF狭窄行PTA术后再狭窄的临界点。超声操作简便、无创、无辐射，不仅可以评估AVF的功能状态以及术中超声引导临床行PTA手术，术前超声检查AVF狭窄长度还可能是预测AVF狭窄行PTA术后再狭窄的独立相关因素。

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2025年第47卷第8期
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doi: 10.16016/j.2097-0927.202409152
  • 接收时间：2024-09-28
  • 首发时间：2026-10-28
  • 出版时间：2025-04-30
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  • 收稿日期：2024-09-28
  • 修回日期：2025-01-16
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    1陆军军医大学（第三军医大学）第一附属医院：超声科，重庆
    2陆军军医大学（第三军医大学）第一附属医院：肾科，重庆

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