预测动静脉内瘘早期通畅率的简易模型

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=2.723,0R=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＜0.001）.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.

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

Objective To establish a simple prediction model for the early patency rate of arteriovenous fistula （AVF）. 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. Re- suits Logistic regression analyses demonstrate that cephalic vein diameter （t=-2.202, OR=2.085）, radial artery diameter （t=-3.493, 0R=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 calcu- lated from risk score model is 0.707 （P 〈 0.001）. 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.