目的 探讨慢性肾脏病（chronic kidney diseae,CKD）患者初次建立动静脉内瘘（arteriovenous fistula,AVF）早期功能失常的危险因素，构建并验证风险预测列线图模型，为临床提供高效、便捷的风险评估工具。方法 回顾性分析2021年2月至2023年4月在某院初次建立AVF的CKD患者（n=200）的临床资料，以7∶3比例将其分为建模集（n=140）和验证集（n=60）。通过单因素和多因素Logistic回归分析筛选独立危险因素，绘制风险预警评分模型列线图，采用受试者工作特征曲线、决策曲线分析和校正曲线评估模型性能。结果 年龄、透析中低血压、钙磷乘积、透析时内瘘血流量是AVF早期功能失常的独立危险因素（均P＜0.05）。建立的列线图预测模型在验证组中表现出良好的预测性能，校准图和校正曲线拟合度良好（均P＜0.05）。结论 构建的风险预测模型具有较好的临床预测价值，有助于早期识别高风险患者并采取干预措施，改善预后。

Objective To investigate the risk factors for early dysfunction after initial arteriovenous fistula (AVF) creation in patients with chronic kidney disease (CKD) and to develop and validate a risk prediction nomogram model,providing an efficient and convenient clinical assessment tool.Methods A retrospective analysis was conducted on clinical data from 200 CKD patients who underwent initial AVF creation at a hospital between February 2021 and April 2023.The patients were divided into a modeling set (n=140) and a validation set (n=60) in a 7:3 ratio.Univariate and multivariate logistic regression analyses were used to identify independent risk factors.A risk warning scoring nomogram was constructed,and model performance was evaluated using receiver operating characteristic (ROC) curves,decision curve analysis (DCA),and calibration curves.Results Age,intradialytic hypotension,calcium-phosphorus product,and intra-dialysis fistula blood flow were identified as independent risk factors for early AVF dysfunction (all P＜0.05).The developed nomogram prediction model demonstrated good predictive performance in the validation group,with well-fitted calibration plots and calibration curves (all P＜0.05).Conclusions The constructed risk prediction model has good clinical predictive value,aiding in the early identification of high-risk patients and facilitating timely intervention to improve prognosis.

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江西省卫生健康委科技计划（202211536）；江西省卫生健康委科技计划（202211544）