Zhang Yu-Meng, Chen Wen, Wei Hai-Lang, Tang Xian-Hu, Xie Fu-Hua, Wang Run-Xiu
Department of Nephrology, The first Affiliated Hospital, Gannan Medical University, Ganzhou, Jiangxi, China.
School of Basic Medicine, Gannan Medical University, Ganzhou, Jiangxi, China.
J Vasc Access. 2024 Jul;25(4):1134-1139. doi: 10.1177/11297298221151135. Epub 2023 Jan 27.
To investigate the predictors of early diagnosis of thrombus of autogenous arteriovenous fistula (aAVF).
The included patients were divided into the thrombus group with aAVF failure or thrombosis and the control group with good internal fistula function. The general data of the patients, including age, sex, diabetes mellitus, were collected. Platelets (PLT), platelet crit (P-LCR), platelet distribution width (PDW), mean platelet volume (MPV), homocysteine (HCY), and other biochemical data were collected. The predictors of thrombus of aAVF were obtained by the t test and logistic regression analysis, and receiver operating characteristic (ROC) curve analysis was used to compare the area under the ROC curve (AUC) between the combined predictors and the original indicators. The optimal critical value was determined when the Youden index reached its maximum value, and the sensitivity, specificity, accuracy, diagnostic index, and so on were calculated. Finally, prediction was performed by substituting each value in individually.
PLT, PDW, P-LCR, MPV, and HCY showed significant differences between two groups ( < 0.05). Logistic regression analysis showed that, for PLT (OR = 1.014, 95% CI 1.006-1.022, = 0.01), PDW (OR = 1.295, 95% CI 1.009-1.661, = 0.042), P-LCR (OR = 1.230, 95% CI 1.089-1.389, = 0.001), MPV (OR = 1.696, 95% CI 1.101-2.613, = 0.017), and HCY (OR = 1.332, 95% CI 1.182-1.502, = 0.01), the difference was significant; PLT, PDW, P-LCR, MPV, and HCY were positively correlated with thrombogenesis ( < 0.05). By logistic regression, a group of the five predictors of PLT, PDW, P-LCR, MPV, and HCY was obtained, and the combined predictors were 0.014PLT + 0.258PDW + 0.207P-LCR + 0.528MPV + 0.287*HCY. The area under the curve of the combined predictor was 0.933, the sensitivity was 92.4%, the specificity was 81.2%, the maximum diagnostic index was 0.736, the diagnostic cutoff point was 21.790, and the accuracy rate was 87%.
PLT, PDW, P-LCR, MPV, and HCY are predictors of thrombus of aAVF. They can better predict thrombus of aAVF, and the combination of these five indicators is better than a single indicator.
探讨自体动静脉内瘘（aAVF）血栓形成早期诊断的预测指标。
将纳入的患者分为aAVF失功或血栓形成的血栓组和内瘘功能良好的对照组。收集患者的一般资料，包括年龄、性别、糖尿病等。采集血小板（PLT）、血小板压积（P-LCR）、血小板分布宽度（PDW）、平均血小板体积（MPV）、同型半胱氨酸（HCY）等生化数据。通过t检验和logistic回归分析获得aAVF血栓形成的预测指标，并采用受试者工作特征（ROC）曲线分析比较联合预测指标与原始指标的ROC曲线下面积（AUC）。当约登指数达到最大值时确定最佳临界值，并计算敏感性、特异性、准确性、诊断指数等。最后，逐个代入各值进行预测。
两组患者的PLT、PDW、P-LCR、MPV和HCY差异有统计学意义（P<0.05）。logistic回归分析显示，对于PLT（OR=1.014，95%CI 1.006-1.022，P=0.01）、PDW（OR=1.295，95%CI 1.009-1.661，P=0.042）、P-LCR（OR=1.230，95%CI 1.089-1.389，P=0.001）、MPV（OR=1.696，95%CI 1.101-2.613，P=0.017）和HCY（OR=1.332，95%CI 1.182-1.502，P=0.01），差异有统计学意义；PLT、PDW、P-LCR、MPV和HCY与血栓形成呈正相关（P<0.05）。通过logistic回归，获得了PLT、PDW、P-LCR、MPV和HCY这五个预测指标组成的一组指标，联合预测指标为0.014×PLT+0.258×PDW+0.207×P-LCR+0.528×MPV+0.287×HCY。联合预测指标的曲线下面积为0.933，敏感性为92.4%，特异性为81.2%，最大诊断指数为0.736，诊断界值为21.790，准确率为87%。
PLT、PDW、P-LCR、MPV和HCY是aAVF血栓形成的预测指标。它们能更好地预测aAVF血栓形成，且这五个指标联合应用优于单一指标。
