目的 探究自体动静脉内瘘(arteriovenous fistula,AVF)血管周围脂肪组织(perivascular adipose tissue,PVAT)体积及脂肪衰减指数(fat attenuation index,FAI)对血管重塑的调节作用。 方法 纳入2022年5月—12月在南京大学医学院附属苏州医院、包头市中心医院和苏州大学附属第二医院行AVF患者90例，手术后第2天通过CT测量AVF周围径向距离等于血管直径(d)内的脂肪体积和FAI。通过多普勒超声评估患者手术后1年AVF通畅性，并根据《中国血液透析用血管通路专家共识第2版》分为内瘘成熟组和内瘘不良事件组。采用多因素Logistic回归分析明确PVAT体积及FAI对AVF手术后1年内结局指标的影响。 结果 与内瘘成熟组(69例)相比，内瘘不良事件组(21例)患者PVAT体积较小(t=6.572,P=0.018)且FAI较高(t=-4.883,P＝0.025)。多因素分析结果显示：脂肪体积(OR=0.256,95% CI：0.087～0.752，P=0.013)及FAI(OR=1.064,95% CI：1.007～1.124,P=0.026)均为AVF不良事件的独立预测因子。 结论 PVAT是AVF通畅性的重要影响因素，其中脂肪体积为保护因素，FAI为危险因素。可通过手术后早期筛查，识别AVF不良事件高危患者，将其防治关口前移。
Objective To evaluate the regulatory effects of perivascular adipose tissue (PVAT) volume around autologous arteriovenous fistulas (AVF) and fat attenuation index (FAI) on vascular remodeling in patients with AVF. Methods A total of 90 patients undergoing AVF surgery in the three clinical trial centers were enrolled in this study. Fat volume and FAI around the AVF in the area of vessel length equal to the vessel diameter (d) were measured by CT at the second postoperative day. AVF patency after the surgery for one year was assessed by Doppler ultrasound. The patients were then divided into non-adverse event group and adverse event group according to the Chinese Expert Consensus on Vascular Access for Hemodialysis, 2nd edition. Multivariate logistic regression model was used to analyze the impacts of PVAT volume and FAI on AVF patency in one year after surgery. Results Patients in adverse event group (n=21) had less PVAT volume (t=6.572, P=0.018) and higher FAI (t=-4.883, P=0.025) as compared with those in non-adverse event group (n=61). Logistic regression showed that fat volume (OR=0.256, 95% CI:0.087～0.752, P=0.013) and FAI (OR=1.064, 95% CI:1.007～1.124, P=0.026) were the independent predictive factors for AVF adverse events. Conclusion PVAT volume was the protective factors and FAI was the risk factor for AVF patency. Patients with high risk of AVF adverse events can be identified by early postoperative screening, so as to decrease the negative factors and improve the prognosis of AVF.
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