目的 探讨血液透析患者自体动静脉内瘘(arteriovenous fistula，AVF)经皮腔内血管成形术(percutaneous transluminal angioplasty，PTA)后出现再狭窄的危险因素。 方法 选取华中科技大学同济医学院附属同济医院血液净化中心血液透析并首次行PTA的患者，随访12个月；对于12个月内出现AVF再狭窄的患者，收集其出现再狭窄时的相关数据，未出现AVF再狭窄的患者，收集其随访结束时的相关数据。 结果 纳入随访的65名患者中，27例在12个月内出现再狭窄，手术后1个月、3个月、6个月、9个月及1年通畅率分别为100%、93.85%、73.85%、63.08%及58.46%；与未出现AVF再狭窄患者比较，首次PTA术后出现再狭窄患者具备自体AVF使用时间较短(t=2.832，P=0.006)、高钙磷乘积(t=2.240， P=0.029)、低血镁(t=2.090，P=0.041)、低甲状旁腺激素(t=2.587，P=0.012)、高β2-微球蛋白(t=3.024，P=0.003)及透析中低血压(χ2=4.260，P=0.039)等特点；COX多因素回归分析显示AVF使用时间(HR=0.980,95% CI：0.963～0.997，P=0.020)、钙磷乘积(HR=1.045,95% CI：1.009～1.082，P=0.013)、β2-微球蛋白(HR=1.080,95% CI：1.006～1.158,P=0.033)及透析中低血压(HR=3.354, 95% CI：1.548～7.269， P=0.002)是影响首次PTA手术后再狭窄的主要风险因素。 结论 对于首次行自体动静脉内瘘PTA的血液透析患者，可通过加强中大分子毒素清除及预防透析中低血压等措施来预防自体动静脉内瘘再狭窄的发生。
Objective To explore the risk factors for restenosis after percutaneous transluminal angioplasty (PTA) in autologous arteriovenous fistulas (AVF) of hemodialysis patients. Methods A total of 65 patients on hemodialysis after PTA for the first time were selected as the research subjects. They were followed up for 12 months. For patients who developed restenosis within 12 months, the relevant data at the time of restenosis were collected. For those without restenosis, the relevant data at the end of the follow-up were also recruited. The differences in relevant indicators of the patients were analyzed. Cox univariate and multivariate regression analysis was used to analyze the risk factors for restenosis after PTA. Kaplan-Meier and log rank tests were used for univariate survival analysis. Results ①Among the 65 patients followed-up for 12 months, 27 developed restenosis within 12 months. The patency rates at one month, 3, 6, 9 and 12 months after surgery were 100%, 93.85%, 73.85%, 63.08% and 58.46%, respectively. ②Patients who developed restenosis after the first PTA had shorter AVF usage time (t=2.832, P=0.006), higher calcium-phosphorus product (t=2.240, P=0.029), lower blood magnesium (t=2.090, P=0.041), lower PTH (t=2.587, P=0.012), higher β2-microglobulin (t=3.024, P=0.003), and hypotension during dialysis (χ2=4.260, P=0.039). ③COX univariate and multivariate regression analysis revealed that AVF usage time (HR=0.980, 95% CI:0.963～0.997, P=0.020), calcium-phosphorus product (HR=1.045, 95% CI:1.009～1.082, P=0.013), β2-microglobulin (HR=1.080, 95% CI:1.006～1.158, P=0.033), and hypotension during dialysis (HR=3.354, 95% CI:1.548～7.269, P=0.002) were the main risk factors for restenosis after the first PTA. Conclusion For hemodialysis patients undergoing the first PTA in AVF, the occurrence of AVF restenosis can be reduced by controlling chronic kidney disease-mineral and bone disorder (CKD-MBD), strengthening the clearance of middle and large molecular toxins, and preventing hypotension during dialysis.
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