Ishii Takeo, Suzuki Yasunobu, Nakayama Takuji, Ohmori Miki, Masai Shinichi, Sasagawa Naru, Ohyama Kunio
Zenjinkai Group, Internal Medicine, Yokohama-Daiichi Hospital, Yokohama, Kanagawa - Japan.
Department of Epidemiology and Public Health, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa - Japan.
J Vasc Access. 2016 Nov 2;17(6):499-505. doi: 10.5301/jva.5000595. Epub 2016 Sep 27.
To determine if duplex ultrasound (US) for arteriovenous fistulas (AVFs) can predict vascular events (VEs; thrombosis and stenosis).
Duplex US was performed for vascular access evaluation in 2557 maintenance hemodialysis (HD) patients between October 1, 2013 and March 31, 2016. Of these patients, 2184 patients were finally included in this study. AVF dysfunction was assessed using the brachial artery blood flow volume (Qa; mL/min), arterial blood flow resistance index (RI), and residual diameter of the fistula vein (RD; mm). Proximal, midpoint, and distal aspects of the fistulas were measured. The baseline measurements were the US assessments, and the endpoint was VEs requiring vascular access intervention therapy or vascular surgery. Associations of US findings and VEs were assessed with receiver operating characteristic curve analysis, log-rank analysis, and multivariate Cox hazard models.
The mean Qa was 772.8 ± 441.4 mL/min; RI, 0.56 ± 0.1; and RD, 2.37 ± 1.0 mm. The optimal Qa cut-off point was calculated as 581.5 mL/min, RI cut-off as 0.56, and RD cut-off as 1.85 mm. VEs were more frequent in patients with a Qa <581.5 mL/min than in those with a Qa >581.5 mL/min (p<0.001). In multivariate analysis, Qa, ferritin, transferrin saturation, and warfarin use were significantly associated with VEs.
US evaluation of AVFs in HD patients is a simple method to predict the risks of thrombosis and fistula dysfunction. Qa, ferritin, transferrin saturation, and warfarin use might be associated with VEs.
确定用于动静脉内瘘（AVF）的双功超声（US）能否预测血管事件（VE；血栓形成和狭窄）。
在2013年10月1日至2016年3月31日期间，对2557例维持性血液透析（HD）患者进行双功超声检查以评估血管通路。其中，2184例患者最终纳入本研究。使用肱动脉血流量（Qa；毫升/分钟）、动脉血流阻力指数（RI）和内瘘静脉残余直径（RD；毫米）评估AVF功能障碍。测量内瘘的近端、中点和远端。基线测量为超声评估，终点为需要血管通路干预治疗或血管手术的VE。通过受试者操作特征曲线分析、对数秩分析和多变量Cox风险模型评估超声检查结果与VE的相关性。
平均Qa为772.8±441.4毫升/分钟；RI为0.56±0.1；RD为2.37±1.0毫米。计算得出最佳Qa截断点为581.5毫升/分钟，RI截断点为0.56，RD截断点为1.85毫米。Qa<581.5毫升/分钟的患者发生VE的频率高于Qa>581.5毫升/分钟的患者（p<0.001）。多变量分析中，Qa、铁蛋白、转铁蛋白饱和度和华法林的使用与VE显著相关。
对HD患者的AVF进行超声评估是预测血栓形成和内瘘功能障碍风险的简单方法。Qa、铁蛋白、转铁蛋白饱和度和华法林的使用可能与VE相关。
