血液透析患者自体动静脉内瘘血栓形成风险预测模型的Meta分析

doi:10.3761/j.issn.0254-1769.2026.09.017

摘要/Abstract

摘要：

目的系统评价血液透析患者自体动静脉内瘘（arteriovenous fistula，AVF）血栓形成风险的预测模型，为临床筛选或开发高质量的风险评估工具提供参考。方法检索PubMed、Embase、Cochrane Library、Web of Science、CINAHL、Medline、中国知网、万方数据库、维普数据库和中国生物医学文献数据库，检索时限为建库至2026年1月20日。由2名研究者独立完成文献筛选、资料提取及偏倚风险评估，使用MedCalc 23.0.1软件对各模型的曲线下面积进行Meta分析。结果共纳入9项研究，涉及15个预测模型，样本总量为5 280例。敏感性分析之后Meta分析结果显示，受试者工作特征曲线下面积为0.833（95%CI：0.808~0.857），异质性检验I²=0（P=0.757）。纳入研究整体适用性较好，但总体偏倚风险较高。共性预测因子包括纤维蛋白原、超敏C反应蛋白、AVF狭窄、血小板、糖尿病，以及压迫止血时间。结论现有血液透析患者AVF血栓形成风险预测模型的开发和验证仍需进一步完善，未来研究应基于真实世界数据，开展大样本、多中心的前瞻性队列研究，从而为血液透析患者AVF血栓形成的二级预防提供实证依据。

关键词: 血液透析, 自体动静脉内瘘, 血栓形成, 预测模型, 系统评价, Meta分析

Abstract:

Objective This systematic review aims to evaluate the predictive models for thrombosis risk in arteriovenous fistulas（AVF） of hemodialysis patients，providing a reference for the clinical screening or development of high-quality risk assessment tools. Methods Databases including PubMed，Embase，Cochrane Library，Web of Science，CINAHL，Medline，CNKI，Wanfang Database，VIP，and CBM were searched from their inception to January 20，2026. There were 2 researchers who independently completed the literature screening，data extraction，and risk of bias assessment. Meta-analysis of the area under the curve of each model was conducted using MedCalc 23.0.1 software. Results A total of 9 studies involving 15 predictive models and 5，280 cases were included. After sensitivity analysis，the meta-analysis result was of the area under the curve 0.833（95%CI：0.808~0.857），with heterogeneity test I²=0（P=0.757）. The overall applicability of the included studies was good，but the overall risk of bias was high. Common predictive factors included fibrinogen，high-sensitivity C-reactive protein，AVF stenosis，platelets，diabetes，and compression hemostasis time. Conclusion The development and validation of predictive models for AVF thrombosis risk in hemodialysis patients still need to be further improved. Future research should be based on real-world data and conduct large-sample，multi-center prospective cohort studies to provide empirical evidence for secondary prevention of AVF thrombosis in hemodialysis patients in China.

Key words: Hemodialysis, Autologous Arteriovenous Fistula, Thrombosis, Predictive Model, Systematic Review, Meta-Analysis

李田田, 渠楠, 崔丽萍, 蔚玲, 张莉峰, 程伊薇, 孙双. 血液透析患者自体动静脉内瘘血栓形成风险预测模型的Meta分析[J]. 中华护理杂志, 2026, 61(9): 1269-1276.

LI Tiantian, QU Nan, CUI Liping, WEI Ling, ZHANG Lifeng, CHENG Yiwei, SUN Shuang. Risk prediction models for thrombosis in autologous arteriovenous fistulas in hemodialysis patients：a Meta-analysis[J]. Chinese Journal of Nursing, 2026, 61(9): 1269-1276.

图/表 5

图1 文献筛选流程

Figure 1 Flowchart of literature screening

表1 纳入研究的基本特征（n=9）

Table 1 Basic characteristics of included studies（n=9）

表2 纳入模型的基本特征（n=9）

Table 2 Basic characteristics included in the model（n=9）

表3 纳入研究的偏倚风险和适用性评价（n=9）

Table 3 Evaluation of the risk of bias and applicability of the included studies（n=9）

图2 受试者操作特征曲线下面积合并效应量森林图

Figure 2 Forest plot of pooled AUC effect size

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