目的 探讨超声对自体动静脉内瘘(arteriovenous fistula，AVF)内膜增生性狭窄经皮血管腔内成形术(percutaneous transluminal angioplasty,PTA)手术效果预测价值。 方法 收集山西白求恩医院、山西省第二人民医院因动静脉内瘘血管内膜增生导致内瘘狭窄而行超声引导下PTA治疗的患者60例，根据手术前超声检查狭窄段血管内膜厚度分为3组：轻度组：0.5mm ≤ 内膜厚度＜1.0mm；中度组：1.0mm ≤ 内膜厚度 ≤ 1.5mm；重度组：内膜厚度＞1.5mm。观察各组患者手术效果及复发时间与血管内膜厚度之间的关系。 结果 3组患者既往PTA次数(F =11.243，P＜0.001)、手术前血管内径(F =12.806， P＜0.001)、手术后血管内径(F =44.935，P＜0.001)、手术前血流量(F =17.486，P＜0.001)、手术后血流量(F =37.244，P＜0.001)、复发时间(F =49.434,P＜0.001)比较有统计学差异；轻度组PTA手术后3个月及6个月通畅率为100%及84.6%，高于中度组和重度组(χ2=22.652，P＜0.001；χ2=27.754，P＜0.001)；患者年龄、既往PTA次数以及动静脉内瘘内膜厚度与PTA手术后狭窄复发时间独立相关(β分别为：-0.169、-0.618、-2.933；P分别为：0.042、0.028、＜0.001)。 结论 患者年龄，既往PTA次数及内膜厚度是PTA手术后复发时间的独立危险因素。
Objective To investigate ultrasound examination in the prediction of percutaneous transluminal angioplasty (PTA) on hyperplastic stenosis in autogenous arteriovenous fistula (AVF). Methods A total of 60 patients with AVF stenosis due to intimal hyperplasia and treated with ultrasound-guided PTA in Shanxi Bethune Hospital and Shanxi Second People’s Provincial Hospital were recruited for analyses. They were divided into 3 groups based on the intimal thickness measured by preoperative ultrasonography: mild group (intimal thickness ≥0.5mm and ＜1.0mm), moderate group (intimal thickness≥1.0mm and ≤1.5mm), and severe group (intimal thickness ≥1.5mm). The relationship between intimal thickness and postoperative effect and relapse was evaluated. Results Preoperative vascular diameter (F=12.806, P＜0.001), postoperative vascular diameter (F=44.935, P<0.001), previous PTA times (F=11.243, P＜0.001), preoperative vascular inner diameter (F=12.806, P＜0.001), postoperative vascular inner diameter (F=44.935, P＜0.001), preoperative blood flow (F=17.486, P＜0.001), postoperative blood flow (F=37.244, P＜0.001), and relapse time (F=49.434, P＜0.001) were significantly different among the 3 groups. The patency rates after PTA for 6 months in mild group were 100% and 84.6%, higher than those in moderate group (χ2=22.652, P＜0.001) and severe group (χ2=27.754, P＜0.001). Age, previous PTA times and preoperative intimal thickness were independently correlated with the relapse time of postoperative AVF stenosis (β=-0.169, -0.618 and -2.933 respectively; P=0.042, 0.028, and＜0.001 respectively). Conclusion The age of patients, number of previous PTA and thickness of intima are the independent risk factors for relapse time after PTA.
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