维持性血液透析病人动静脉内瘘失功风险预测模型的构建
Construction of a risk prediction model for arteriovenous fistula loss in maintenance hemodialysis patients
万婷 1曹韦娜1
作者信息
- 1. 景德镇市第二人民医院,江西 333000
- 折叠
摘要
目的:探讨影响维持性血液透析病人动静脉内瘘失功的危险因素,构建风险列线图模型并验证.方法:选取我院于2022年6月—2023年6月入院的133例维持性血液透析病人作为研究对象,分析维持性血液透析病人动静脉内瘘失功的危险因素,并绘制相应的列线图,采用受试者工作特征(ROC)曲线、校准曲线及拟合优度检验评估模型的预测性能;采用临床决策曲线评估模型的临床适用性.结果:133例维持性血液透析病人中,30例(22.6%)发生动静脉内瘘失功.Logistic回归分析显示,高龄(≥60岁)、主动脉弓钙化、穿刺技术不熟练、低血压、吸烟史、血栓形成是病人发生动静脉内瘘失功的独立危险因素.构建的风险预测模型的ROC曲线下面积(AUC)为0.908,敏感度为93.30%,特异度为69.90%;校准曲线结果显示,模型预测概率与实际发生情况之间具有良好的一致性;临床决策曲线结果显示,模型具有较高的临床实用价值.结论:维持性血液透析病人动静脉内瘘失功受多种因素影响,基于危险因素构建的预测模型具有较高的临床应用价值.
Abstract
Objective:To explore the risk factors for arteriovenous fistula(AVF)failure in patients undergoing maintenance hemodialysis(MHD),construct a risk nomogram model,and validate its performance.Methods:A total of 133 MHD patients admitted to our hospital from June 2022 to June 2023 were selected as study subjects.The risk factors for AVF failure in MHD patients were analyzed,and a corresponding nomogram was developed.The predictive performance of the model was assessed using the Receiver Operating Characteristic(ROC)curve,calibration curve,and goodness-of-fit test.The clinical applicability of the model was evaluated using the clinical decision curve.Results:Among the 133 MHD patients,30(22.6% )experienced AVF failure.Logistic regression analysis revealed that advanced age(≥60 years),aortic arch calcification,inexperienced puncture technique,hypotension,smoking history,and thrombosis were independent risk factors for AVF failure.The area under the ROC curve(AUC)of the constructed risk prediction model was 0.908,with a sensitivity of 93.30% and a specificity of 69.90% .The calibration curve results showed good agreement between the model's predicted probabilities and actual occurrences.The clinical decision curve results indicated that the model had high clinical applicability.Conclusion:AVF failure in MHD patients is influenced by multiple factors,and the predictive model based on these risk factors has high clinical application value.
关键词
血液透析/动静脉内瘘失功/影响因素/预测模型/调查研究Key words
hemodialysis/arteriovenous fistula loss/influencing factors/prediction model/investigation and research引用本文复制引用
出版年
2025
国家科技期刊平台
NSTL
万方数据