主动脉夹层胸主动脉腔内修复术后肾体积减少的流体力学研究  

Hydrodynamic study of renal volume reduction after thoracic endovascular aortic repair for aortic dissection

作　　者：霍英松 吴佳华 高雨佳 殷信道[1] 陈国中 HUO Yingsong;WU Jiahua;GAO Yujia;YIN Xindao;CHEN Guozhong(Department of Radiology,Nanjing First Hospital,Nanjing 210006,China)

机构地区：[1]南京市第一医院医学影像科,江苏南京210006

出　　处：《实用放射学杂志》2023年第11期1783-1786,共4页Journal of Practical Radiology

基　　金：中国博士后科学基金面上资助项目(2022M711664)。

摘　　要：目的探讨基于计算流体力学(CFD)研究B型主动脉夹层(TBAD)胸主动脉腔内修复术(TEVAR)术后血流动力学改变与肾体积减少之间的潜在关系。方法回顾性分析TEVAR术前及术后1年CT血管成像(CTA)图像。基于CTA构建主动脉模型并进行CFD模拟,获取主动脉入口及肾动脉入口的收缩末期压力及质量流量。测量双肾在手术前后体积变化,根据体积是否减少分为正常组和减少组。结果102例肾脏中73例体积减少。与正常组相比,减少组主动脉入口压力(P=0.019)、质量流量比(P=0.000)、压力比(P=0.046)增高,而肾动脉入口质量流量(P=0.000)减低。质量流量比[比值比(OR)0.981,95%置信区间(CI)0.970~0.992;P=0.001]、主动脉入口压力(OR 0.585,95%CI 0.357~0.957;P=0.033)为肾体积减小的独立风险因素。基于质量流量比、主动脉入口压力、质量流量比与主动脉入口压力相结合的模型预测肾体积减少的效能分别为0.791(95%CI 0.699~0.882)、0.649(95%CI 0.533~0.766)和0.822(95%CI 0.097~0.259)。结论TEVAR术后肾体积减少与血流动力学改变密切相关,基于CFD获得的血流动力学参数可能有助于早期预测术后肾体积减少。Objective To investigate the potential relationship between hemodynamic changes and renal volume reduction of type B aortic dissection(TBAD)after thoracic endovascular aortic repair(TEVAR)based on computational fluid dynamics(CFD).Methods Retrospective analysis of computed tomography angiography(CTA)images before and 1 year after TEVAR.The aortic models were built based on CTA.The end systolic pressure and mass flow at the aortic inlet and the renal artery inletwas obtained by CFD simulation.The volume changes of both kidneys before and after TEVAR were measured and divided into normal and reduced groups.Results Of 102 kidneys,73 renal volumes were reduced.The aortic inlet pressure(P=0.019),mass flow ratio(P=0.000),pressure ratio(P=0.046)in reduced group were higher than those in normal group,while the renal artery inlet mass flow(P=0.000)was lower than that in normal group.Mass flow ratio[odds ratio(OR)0.981,95%confidence interval(CI)0.970-0.992;P=0.001]and aortic inlet pressure(OR 0.585,95%CI 0.357-0.957;P=0.033)were independent risk factors for renal volume reduction.The performances in predicting renal volume reduction of models based on mass flow ratio,aortic inlet pressure,and mass flow ratio combined with aortic inlet pressure were 0.791(95%CI 0.699-0.882),0.649(95%CI 0.533-0.766)and 0.822(95%CI 0.097-0.259),respectively.Conclusion Renal volume reduction after TEVAR is closely related to hemodynamic changes.The hemodynamic parametersobtained from CFD may be useful for early predicting renal volume reduction after TEVAR.

关 键 词：主动脉夹层 肾体积 计算流体动力学 

分 类 号：R543.1[医药卫生—心血管疾病] R692.12[医药卫生—内科学]