含CT影像特征的主动脉夹层动脉瘤患者术后附壁血栓形成的列线图模型构建  

Construction of containing CT imaging features Nomograms model of postoperative intraluminal thromus formation in patients with aortic dissective aneurysm

作　　者：李静[1] 汤丽[2] 陈安强 杨自力[1] 安丽华[1] 冯海霞[1] Li Jing;Tang Li;Chen Anqiang;Yang Zili;An Lihua;Feng Haixia(Department of Medical Imaging,Affiliated Hospital of Jining Medical College,Jining 272000,China;Department of Cardiology and Critical Medicine,Affiliated Hospital of Jining Medical College,Jining 272000,China)

机构地区：[1]济宁医学院附属医院医学影像科,济宁272000 [2]济宁医学院附属医院心脏重症医学科,济宁272000

出　　处：《中国医师进修杂志》2023年第10期914-920,共7页Chinese Journal of Postgraduates of Medicine

基　　金：山东省自然科学基金(ZR2021MH346)。

摘　　要：目的探讨含CT影像特征的主动脉夹层动脉瘤(ADA)患者术后附壁血栓(ILT)形成的列线图模型构建。方法回顾性选取2020年5月至2022年2月济宁医学院附属医院诊治的120例Stanford B型ADA患者,均行覆膜支架腔内修复术及多层螺旋CT(MSCT)检查。按7∶3比例将患者随机分为建模人群(84例)、验证人群(36例)。在建模人群中统计术后1个月内ILT形成情况,通过单因素和多因素Logistic回归模型分析ADA患者术后ILT形成的影响因素,并构建术后ILT形成的列线图预测模型,分别在建模人群及验证人群中对预测模型进行内部及外部验证。结果在建模人群中,术后有ILT形成23例(27.38%),其中5例ILT位于主动脉弓部,18例ILT位于腹主动脉。单因素分析结果显示,术后ILT形成组与无ILT形成组性别构成、年龄、体质量指数(BMI)、吸烟、饮酒、高血压、高脂血症、破口直径、破口距左锁骨下动脉距离、重要分支受累、动脉瘤壁不均匀增厚、平扫呈低密度、手术时机比较差异无统计学意义(P>0.05);两组糖尿病、内壁不规则、伴有钙化斑块、术后抗凝治疗及B型脑钠肽(BNP)、纤维蛋白原(Fib)、D-二聚体(D-D)、C反应蛋白(CRP)水平[43.48%(10/23)比11.48%(7/61)、86.96%(20/23)比57.38%(35/61)、91.30%(21/23)比62.30%(38/61)、21.74%(5/23)比57.38%(35/61)、(523.60±128.74)ng/L比(271.83±109.65)ng/L、(3.82±0.96)g/L比(2.85±0.83)g/L、(601.37±75.62)μg/L比(389.20±68.79)μg/L、(0.63±0.19)mg/L比(0.48±0.15)mg/L]比较差异有统计学意义(P<0.05)。Logistic多因素分析结果显示,糖尿病、内壁不规则、伴有钙化斑块、术后抗凝治疗和BNP、Fib、D-D、CRP水平均为Stanford B型ADA患者术后ILT形成的影响因素(P<0.05)。根据影响因素构建Stanford B型ADA患者覆膜支架腔内修复术后ILT形成的列线图预测模型,该模型在建模人群、验证人群的一致性指数分别为0.903、0.894,具有良好的区分度,且在预测Stanford Objective To investigate the construction of containing CT imaging features Nomograms model of postoperative intraluminal thromus(ILT)formation in patients with aortic dissective aneurysm(ADA).Methods One hundred and twenty patients with Stanford type B ADA treated with overlapping stent endoluminal repair and multilayer spiral CT(MSCT)examination in Affiliated Hospital of Jining Medical College from May 2020 to February 2022 were selected.The patients were divided into the modeling population(84 patients)and the validation population(36 patients)according to a 7∶3 ratio.The factors influencing postoperative ILT formation in ADA patients were analyzed by univariate and Logistic multifactor regression models,and the prediction model of postoperative ILT formation was constructed based on the influencing factors.Results In the modeled population,the rate of ILT formation within 1 month after luminal repair with overlapping stents was 27.38%(23/84),including 5 cases in the aortic arch and 18 cases in the abdominal aorta.In the modeled population,the results of univariate analysis showed that the sex,age,body mass index(BMI),smoking,drinking,hypertension,hyperlipidemia,rupture diameter,rupture distance from left subclavicular artery,involvement of important branches,uneven thickening of aneurysm wall,low density on plain scan and operation timing between the ILT formation group and non-ILT formation group had no statistically significant(P>0.05).The diabetes mellitus,irregular inner wall,calcified plaque,postoperative anticoagulant therapy,B-type brain natriuretic peptide(BNP),fibrinogen(Fib),D-dimer(D-D)and C-reactive protein(CRP)between the two groups had statistical differences:43.48%(10/23)vs.11.48%(7/61),86.96%(20/23)vs.57.38%(35/61),91.30%(21/23)vs.62.30%(38/61),21.74%(5/23)vs.57.38%(35/61),(523.60±128.74)ng/L vs.(271.83±109.65)ng/L,(3.82±0.96)g/L vs.(2.85±0.83)g/L,(601.37±75.62)μg/L vs.(389.20±68.79)μg/L,(0.63±0.19)mg/L vs.(0.48±0.15)mg/L,P<0.05.The results of Logistic multifactor regression analys

关 键 词：主动脉瘤 夹层 支架 体层摄影术 螺旋计算机 附壁血栓 列线图 

分 类 号：R543.1[医药卫生—心血管疾病] R816.2[医药卫生—内科学]