目的 探讨自体动静脉内瘘的动脉-瘘管直径比对行经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)的患者手术后1年血管通路通畅性的影响。 方法 符合研究要求的维持性血液透析患者70例作为研究对象，对患者进行12个月的随访。当患者因再次失功需再次行PTA手术或进行内瘘再造时结束随访，将初级通畅时间＜12个月分为A组(n=24)，初级通畅时间≥12个月为B组(n=46)，观察透析通路PTA后的初级通畅性。收集2组患者的基本临床资料，并进行统计学分析。 结果 A组患者年龄(t=8.237,P＜0.001)、内瘘动脉-瘘管直径比(t=4.251,P＜0.001)高于B组。Logistic回归分析显示：较高的内瘘动脉-静脉直径比是PTA手术后1年内再狭窄的独立预测因素(OR=0.000,95% CI:0.000～0.033,P=0.002)。ROC曲线分析显示内瘘动脉-静脉直径比曲线下面积(AUC)为0.788(95% CI:0.667～0.909，P＜0.001)，具有预测价值，其内瘘动脉-静脉直径比临界值为0.752。约登指数为0.576，敏感度为75.0%，特异度为82.6%。 结论 动脉-瘘管直径比高的PTA治疗患者手术后1年内存在较高的再次内瘘失功风险。
Objective To investigate the effect of artery-to-fistula diameter ratio of the arteriovenous fistula (AVF) on vascular access patency in patients after percutaneous transluminal angioplasty (PTA) for one year. Methods A total of 70 patients with maintenance hemodialysis and met the requirements of the study were selected as the study subjects. They were followed up for 12 months. When the patients needed to treat with PTA or AVF reconstruction due to re-occlusion, follow-up was terminated. According to the primary patency time, they were divided into two groups: group A (n=24, primary patency time ＜12 months) and group B (n=46, primary patency time ≥12 months) to observe their primary patency after PTA. Clinical characteristics of the two groups were collected and compared. Results The average age of group A was 72.33 years (range 65.22～79.44), significantly higher than that of group B (58.00 years, range 51.19～64.81). However, the artery-to-fistula diameter ratio of AVF were significantly higher in group A than in group B (t=4.251, P＜0.001). Logistic regression showed that a higher artery-to-fistula diameter ratio of AVF was an independent predictor of restenosis within one year after PTA (OR=0.000, 95% CI: 0.000～0.033, P=0.002). ROC curve analysis showed that the area under the curve (AUC) of the artery-to-fistula diameter ratio of the AVF was 0.788 (95% CI: 0.667～0.909, P＜0.05), and the cut-off value of the artery-to-fistula diameter ratio of the AVF was 0.752. The Youden index was 0.576, the sensitivity was 75.0%, and the specificity was 82.6%. Conclusion Patients with a higher artery-to-fistula diameter ratio of the AVF after PTA have a higher risk of re-fistula failure within one year.
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