【摘要】目的通过对新建立的腕部桡动脉-头静脉吻合内瘘(radial-cephalic arteriovenous fistula，RC-AVF)术后超声随访检查，明确RC-AVF 的自然成熟过程。方法收集本中心符合纳入标准的新建立RC-AVF 的患者。术后第2～24 周进行规律超声随访检查。通过重复测量方差分析超声监测指标随时间的变化特点，进一步采用ROC 曲线分析相关指标对于内瘘成熟的诊断效能。结果24 周时RC-AVF的通畅率为71.43%。超声监测指标随时间的变化特点显示：肱动脉内径和头静脉内径在RC-AVF 术后的第2～24 周内随时间呈增大的变化趋势(F=3.070，P=0.047；F=7.649，P＜0.001)；2 者在4 周内的变化明显(t=-2.338，P=0.026；t=-4.792，P=0.003)。通畅组与失败组比较结果显示：头静脉内径和头静脉血流量从术后第2～24 周2 组间的差异始终具有显著性(P＜0.05)。ROC 曲线分析示头静脉内径=4.28mm 为最佳临界值(AUC=0.882)，其预测AVF 成熟的敏感度为81.82%，特异度为86.67%；头静脉血流量=701.580ml/min 为最佳临界值(AUC=0.873)，其预测AVF 成熟的敏感度为72.73%，特异度为93.33%。结论新建立的RC-AVF 在术后的4 周内快速成熟，头静脉内径和头静脉血流量是判断RC-AVF 成熟的主要标志，诊断的最佳临界值分别为4.28mm 和701.580ml/min。

【Abstract】Objective To explore the ultrasonic examination for the evaluation of maturation process of newly established radial- cephalic arteriovenous fistula (RC-AVF) within 24 weeks after surgery. Method In this single center clinical study, RC-AVFs performed from October 2016 to January 2018 were included in this study. Ultrasound follow-up examinations were performed after surgery. Patients were divided into patency group and failure group. The ultrasonic parameters at different follow-up time points were compared. ROC curve was used to analyze the diagnostic value of ultrasonic monitoring parameters. Results The patency rate of RC-AVF at the 24th week was 71.43%. The internal diameter of brachial artery (t=-2.338, P=0.029) and cephalic vein (t=- 4.792, P=0.003) increased gradually within 4 weeks after surgery in patency group, while the changes were not significant between 4th to 24th week (P> 0.050). The internal diameter of cephalic vein and its blood flow were always significantly different between the two groups during the follow-up period (P ＜0.05). When the optimal cut-off value of cephalic vein diameter was set at 4.28mm, the sensitivity and specificity were 81.82% and 86.67% respectively for predicting maturation of AVF and AUC=0.882; when the optimal cut-off value of blood flow in cephalic vein was set at 701.580ml/min, the sensitivity and specificity were 72.73% and 93.33% respectively for predicting maturation of AVF and AUC=0.873. Conclusion The newly established RC-AVF matures rapidly within 4 weeks after surgery. The internal diameter of cephalic vein and its blood flow were the main parameters of RC-AVF maturity. The optimal cut-off values for the diagnosis of RC-AVF maturation were internal diameter of cephalic vein 4.28mm and blood flow in cephalic vein 701.580ml/min respectively.