老年MHD患者AVF并发症危险因素分析及列线图模型构建-现代医学

老年MHD患者AVF并发症危险因素分析及列线图模型构建

单位：南京医科大学附属淮安第一医院血液净化中心, 江苏淮安 223300

分类号：R459.5

出版年·卷·期（页码）：2025·53·第一期（22-27）

摘要：

目的: 分析老年维持性血液透析(MHD)患者并发自体动静脉内瘘(AVF)相关并发症的危险因素，并构建列线图预测模型，以便改善动静脉内瘘相关并发症防控现状。方法: 回顾性分析2021年1月至2024年1月就诊于淮安市第一人民医院血液净化中心的150例老年MHD患者病历资料，依据AVF相关并发症发生情况，将患者分为并发症组和无并发症组，比较两组患者的人口学特征、原发病、AVF穿刺方法、透析时间、AVF自护能力。采用单因素Logistic回归分析确定并发症发生危险因素，构建Logistic回归列线图模型，绘制受试者工作特征曲线、校准曲线及决策曲线。结果: 150例老年MHD患者中出现AVF相关并发症者49例，发生率为32.67%。年龄＞70岁、糖尿病、纽扣式穿刺法为AVF并发症发生的独立危险因素，两指推法及动静脉内瘘自我护理能力量表(ASBHD-AVF)评分≤98分为独立保护因素。构建列线图预测模型的曲线下面积(AUC)为0.85(0.78～0.92)，准确度为0.77(0.70～0.84)，灵敏度为0.74(0.66～0.83)，特异度为0.84(0.73～0.94)，截断值为0.278。预测概率与实际概率比较，差异无统计学意义(χ²=4.767,P=0.782)。结论: 年龄＞70岁、糖尿病、纽扣式穿刺法为老年MHD患者并发AVF相关并发症的危险因素，开展两指推法及提升患者自护能力有益于降低相关并发症发生风险，构建列线图预测模型对防控AVF相关并发症具有良好的预测价值。

Objective: To analyse the risk factors of complications associated with autogenous arteriovenous fistula(AVF) in elderly maintenance hemodialysis(MHD) and construct a nomogram prediction model in order to improve the current situation of prevention and control of complications related toAVF. Methods: Clinical data of 150 elderly MHD patients admitted to the blood purification center of Huai'an first people's hospital from January 2021 to January 2024 were retrospectively analyzed. According to AVF related complications, the patients were divided into complication group and non-complication group.The demographic characteristics of patients, primary disease, AVF puncture method, dialysis time, self-care ability of AVF were compared between the two groups. Univariate and logistic regression analyses were used to determine the risk factors of complications, and a logistic regression nomogram model was constructed to draw the receiver working characteristic curve, calibration curve and decision curve. Results: Among the 150 elderly patients with MHD, 49 had AVF-related complications, with an incidence of 32.67%. Age>70 years, diabetes mellitus and button puncture were independent risk factors of AVF complications, and Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis(ASBHD-AVF) score ≤98 points were independent protective factors. The area under the curve(AUC) of constructed nomogram prediction model was 0.85(0.78-0.92), an accuracy of 0.77(0.70-0.84), a sensitivity of 0.74(0.66-0.83) and a specificity of 0.84(0.73-0.94) and a cutoff value of 0.278. Comparison of the predicted probability with the actual probability showed that there was no statistically significant difference(χ²=4.767,P=0.782). Conclusion: Age>70 years, diabetes and button puncture method are the risk factors of AVF-related complications in elderly MHD patients. The two-finger push method and the improvement of self-care ability of patients are conducive to reducing complication-related risks, and the constructed nomogram prediction model has good predictive value for the prevention and control of AVF-related complications.

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