经导管主动脉瓣置换术后重度主动脉瓣狭窄患者合并糖尿病的临床特征及其短期预后  

Clinical characteristics of severe aortic stenosis patients combined with diabetes mellitus after transcatheter aortic valve replacement and short-term outcome

作　　者：苏文 台适[1] 黄亿源[1] 胡信群[1] 周胜华[1] 方臻飞[1] SU Wen;TAI Shi;HUANG Yiyuan;HU Xinqun;ZHOU Shenghua;FANG Zhenfei(Department of Cardiovascular Medicine,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院心血管内科,长沙410011

出　　处：《中南大学学报（医学版）》2022年第3期309-318,共10页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81801394);湖南省科技厅重点领域研发计划(2021SK2004)。

摘　　要：目的:2型糖尿病是退行性主动脉瓣狭窄(aortic stenosis,AS)患者的常见合并症,且作为美国胸外科医师学会(Society of Thoracic Surgeons,STS)评分的关键条目,对传统开胸手术临床预后的判断具有至关重要的影响。2型糖尿病会使心血管疾病的发病率和病死率上升,同时,在AS患者中2型糖尿病与心肌肥厚重构、左心室功能降低以及心力衰竭症状加重有关。经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)作为介入方式置换主动脉瓣,对于外科中高风险的患者具有更好的安全性,但2型糖尿病对于AS患者行TAVR术后临床结局的影响并不明确。本研究通过分析接受TAVR治疗且合并2型糖尿病的AS患者的临床和影像特征,旨在探讨2型糖尿病对TAVR围手术期并发症及其预后的影响。方法:选取2016年1月至2020年12月在中南大学湘雅二医院连续进行的100例行TAVR治疗且随访时间超过1个月的重度AS患者。其中5例因单纯重度主动脉瓣反流行TAVR治疗的患者未被纳入,故入选患者数为95例,年龄为(72.7±4.8)岁,男58例(61.1%),合并中度以上主动脉瓣反流者30例(31.6%)。依据是否合并2型糖尿病将患者分为糖尿病组(n=16)和非糖尿病组(n=79),两组患者的年龄、性别、体重指数、STS评分和纽约心脏病协会(New York Heart Association,NYHA)心功能分级差异均无统计学意义(均P>0.05)。主要终点定义为术后1个月全因死亡和卒中组成的复合事件,次要终点定义为术后出现的即刻及1个月TAVR术后的相关并发症。比较两组患者术前临床资料、心脏超声数据、CT测量数据、术后用药情况以及各终点事件的发生率。通过单因素和多因素logistic回归构建不良事件的预测模型。结果:与非糖尿病组比较,糖尿病组多存在高血压以及慢性肾功能不全。术前超声心动图两组间差异无统计学意义,术前CT评估发现糖尿病组患者主动脉根部解剖�Objective: Type 2 diabetes(T2DM) is a common comorbidity in patients with degenerative aortic stenosis(AS). As a key item of the American Society of Thoracic Surgeons(STS) score, it has a vital impact on the clinical prognosis of traditional thoracic surgery. T2DM has an adverse effect on the morbidity and mortality of cardiovascular diseases. At the same time, studies have shown that T2DM are associated with myocardial hypertrophy and remodeling, decreased left ventricular function, and worsening heart failure symptoms in the AS patients. Transcatheter aortic valve replacement(TAVR) as an interventional method to replace the aortic valve has better safety for middle and high risk patients in surgery, but the impact of T2DM on the clinical outcome of TAVR in AS patients is not clear.By analyzing the clinical and image characteristics of patients with AS and T2DM who received TAVR treatment, so as to explore the effect of T2DM on the perioperative complications and prognosis of TAVR.Methods: A total of 100 consecutive patients with severe AS, who underwent TAVR treatment and were followed up for more than 1 month, were selectedin the Second Xiangya Hospital of Central South University from January 2016 to December 2020.Among them, 5 patients who were treated with TAVR due to simple severe aortic regurgitation were not included, therefore a total of 95 patients with severe aortic stenosis were enrolled in this study.The age of the patients was(72.7±4.8) years old, and there were58 males(61.1%), and the patients with moderate or above aortic regurgitation had 30cases(31.6%). The patients were divided into a diabetic group and a non-diabetic group according to whether they were combined with T2DM.There was no statistical difference in age, gender, body mass index(BMI), STS score, and New York Heart Association(NYHA)cardiac function classification between the 2 groups(all P>0.05). The primary end point was defined as a composite event consisting of all-cause death and stroke one month after surgery, and the secondary

关 键 词：经导管主动脉瓣置换术 2型糖尿病 主动脉瓣狭窄 

分 类 号：R654.2[医药卫生—外科学] R587.1[医药卫生—临床医学]