用于检测经桡动脉-头静脉内瘘行血液透析患者中心静脉狭窄的腋静脉血流频谱定量模型的价值
Value of a quantitative model of axillary venous blood flow spectrum for the detection of central venous stenosis in patients undergoing hemodialysis via radiocephalic arteriovenous fistula.
作者信息
Xu Xiang, Zhuang Yong, Zeng Jinshu, Cai Fanggang, He Tianmin, Wu Jie, Chen Caiming, Zou Zhenhuan, Zhang Xiaohong, Lv Guorong
机构信息
Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Department of Vascular Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
出版信息
Ann Transl Med. 2022 Jan;10(2):77. doi: 10.21037/atm-22-160.
BACKGROUND
Central venous stenosis (CVS) of radiocephalic arteriovenous fistula (RCAVF) affects RCAVF function and longevity. Ultrasound screening for CVS is limited by acoustic window. Herein, we analyzed the quantitative axillary venous (AxV) spectrum in hemodialysis patients via RCAVF, and constructed central venous stenosis index (CVSI) model based on the spectrum parameters to early detect resting asymptomatic CVS.
METHODS
From August 2017 to May 2021, stage 5 chronic kidney disease (CKD) patients dialysed via RCAVF at the First Affiliated Hospital of Fujian Medical University were included in this study. No CVS-related symptoms were found and the pulsation at the arteriovenous anastomosis was normal. However, the patients had the sensation of swelling in the ipsilateral upper limb during dialysis; the venous pressure advanced upon the completion of dialysis; or both (n=52). The inclusion criteria were as follows: (I) Ultrasound (US) showed that the temporal phases of the AxV spectrum were "normal"; and (II) CVS was confirmed by digital subtraction angiography (DSA). The exclusion criteria were as follows: (I) stent placement; (II) multiple stenosis; and (III) placement of central venous catheter. A total of 37 patients participated in the analysis. Eighteen patients were included in the CVS group, and 19 cases without CVS were included in the control group. Independent sample -test was used to screen each parameter of the AxV spectrum, and a CVSI model was constructed by principal component analysis (PCA). The receiver operating characteristic curve (ROC) was applied to analyze the diagnostic value of CVSI.
RESULTS
According to the independent sample -test, 9 parameters were found to have statistical significance (all P<0.05); they were analyzed by PCA, and the CVSI model was constructed. The ROC showed that CVSI had diagnostic value for CVS. When the cut-off value of CVSI was 7.13, the maximum value of the Youden index was 0.842, with a sensitivity of 100% and a specificity of 84.2%.
CONCLUSIONS
The CVSI helps to early detect resting asymptomatic CVS and dramatically increases the detection rate of CVS.
背景
头静脉桡动脉动静脉内瘘（RCAVF）的中心静脉狭窄（CVS）会影响RCAVF的功能和使用寿命。超声筛查CVS受声窗限制。在此，我们通过RCAVF分析了血液透析患者的腋静脉（AxV）定量频谱，并基于频谱参数构建了中心静脉狭窄指数（CVSI）模型，以早期检测静息无症状CVS。
方法
2017年8月至2021年5月，纳入福建医科大学附属第一医院通过RCAVF进行透析的5期慢性肾脏病（CKD）患者。未发现与CVS相关的症状，动静脉吻合处搏动正常。然而，患者在透析期间同侧上肢有肿胀感；透析结束时静脉压升高；或两者皆有（n = 52）。纳入标准如下：（I）超声（US）显示AxV频谱的时相“正常”；（II）数字减影血管造影（DSA）证实为CVS。排除标准如下：（I）支架置入；（II）多处狭窄；（III）中心静脉导管置入。共有37例患者参与分析。CVS组纳入18例患者，对照组纳入19例无CVS的患者。采用独立样本t检验筛选AxV频谱的各项参数，并通过主成分分析（PCA）构建CVSI模型。应用受试者工作特征曲线（ROC）分析CVSI的诊断价值。
结果
根据独立样本t检验，发现9个参数具有统计学意义（均P < 0.05）；对其进行PCA分析，构建了CVSI模型。ROC显示CVSI对CVS具有诊断价值。当CVSI的截断值为7.13时，约登指数最大值为0.842，灵敏度为100%，特异度为84.2%。
结论
CVSI有助于早期检测静息无症状CVS，并显著提高CVS的检出率。
Zotero 插件