Colombo Alessandro, Provenzano Michele, Rivoli Laura, Donato Cinzia, Capria Marinella, Leonardi Giuseppe, Chiarella Salvatore, Andreucci Michele, Fuiano Giorgio, Bolignano Davide, Coppolino Giuseppe
Dialysis Unit, Hospital of Crotone, Crotone, Italy.
Renal Unit, "Magna Graecia" University, Catanzaro, Italy.
Front Surg. 2021 Jan 25;7:604347. doi: 10.3389/fsurg.2020.604347. eCollection 2020.
The resistance index (RI) and the blood flow volume (Q) are the most used Doppler ultrasound (DUS) parameters to identify the presence of stenosis in arteriovenous fistula (AVF). However, the reliability of these indexes is now matter of concern, particularly in predicting subsequent thrombosis. In this study, we aimed at testing the diagnostic capacity of the Q/RI ratio (Q) for the early identification of AVF stenosis and for thrombosis risk stratification. From a multicentre source population of 336 HD patients, we identified 119 patients presenting at least one "alarm sign" for clinical suspicious of stenosis. Patients were therefore categorized by DUS as stenotic ( = 60) or not-stenotic ( = 59) and prospectively followed. Q, RI, and Q, together with various clinical and laboratory parameters, were recorded. Q and Q were significantly higher while RI was significantly lower in non-stenotic vs. stenotic patients ( < 0.001 for each comparison). At ROC analyses, Q had the best discriminatory power in identifying the presence of stenosis as compared to Q and RI (AUCs 0.976 vs. 0.953 and 0.804; = 0.037 and < 0.0001, respectively). During follow-up, we registered 30 thrombotic events with an incidence rate of 12.65 (95% CI 8.54-18.06) per 100 patients/year. In Cox-regression proportional hazard models, Q showed a better capacity to predict thrombosis occurrence as compared to Q (difference between c-indexes: 0.012; 95% CI 0.004-0.01). In chronic haemodialysis patients, Q might represent a more reliable and valid indicator for the early identification of stenotic AVFs and for predicting the risk of following thrombosis.
阻力指数（RI）和血流量（Q）是用于识别动静脉内瘘（AVF）狭窄的最常用的多普勒超声（DUS）参数。然而，这些指标的可靠性目前令人担忧，尤其是在预测后续血栓形成方面。在本研究中，我们旨在测试Q/RI比值（Q）对AVF狭窄的早期识别和血栓形成风险分层的诊断能力。从336例血液透析患者的多中心源人群中，我们确定了119例出现至少一项临床怀疑狭窄“警示信号”的患者。因此，根据DUS将患者分为狭窄组（=60）和非狭窄组（=59），并进行前瞻性随访。记录Q、RI和Q，以及各种临床和实验室参数。与狭窄患者相比，非狭窄患者的Q和Q显著更高，而RI显著更低（每次比较P<0.001）。在ROC分析中，与Q和RI相比，Q在识别狭窄存在方面具有最佳的鉴别能力（AUC分别为0.976、0.953和0.804；P分别为0.037和P<0.0001）。在随访期间，我们记录了30例血栓形成事件，发病率为每100例患者/年12.65（95%CI 8.54-18.06）。在Cox回归比例风险模型中，与Q相比，Q显示出更好的预测血栓形成发生的能力（c指数之间的差异：0.012；95%CI 0.004-0.01）。在慢性血液透析患者中，Q可能是早期识别狭窄AVF和预测后续血栓形成风险的更可靠和有效的指标。
