腹主动脉瘤腔内修复术后Ⅱ型内漏的影响因素分析和预测模型构建  

Analysis of influencing factors of type II endoleak after abdominal aortic aneurysm endovascular aneurysm repair and establishment of predictive model

作　　者：闫苗苗 孙岩 Yan Miaomiao;Sun Yan(Department of Vascular Surgery,Provincial Hospital Affiliated to Shandong First Medical University,Ji'nan 250021,Shandong,China;Department of Ophthalmology,Provincial Hospital Affiliated to Shandong First Medical University,Ji'nan 250021,Shandong,China)

机构地区：[1]山东第一医科大学附属省立医院血管外科,山东济南250021 [2]山东第一医科大学附属省立医院眼科,山东济南250021

出　　处：《血管与腔内血管外科杂志》2023年第12期1430-1435,共6页Journal of Vascular and Endovascular Surgery

基　　金：山东省中医药科技发展计划(2019-0303);山东省医药卫生科技发展计划(2018WS273)。

摘　　要：目的探讨腹主动脉瘤(AAA)腔内修复术(EVAR)后发生Ⅱ型内漏的影响因素并构建预测模型。方法收集2018年1月至2022年9月于山东第一医科大学附属省立医院进行EVAR治疗的286例AAA患者的临床资料,根据术后随访期间是否发生Ⅱ型内漏将患者分为对照组(n=210)和Ⅱ型内漏组(n=76)。比较两组患者的临床特征、血液指标、AAA解剖情况及手术情况。分析AAA患者EVAR术后发生Ⅱ型内漏的影响因素,构建预测模型,绘制列线图,构建评分系统,并绘制模型的校准曲线,计算一致性指数(C-index),绘制受试者工作特征(ROC)曲线和临床决策曲线,验证预测模型的准确性和临床有效性。结果两组患者的吸烟史比例、肠系膜下动脉(IMA)开口直径、腰动脉(LA)数量和IMA通畅情况比较,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,吸烟史是AAA患者EVAR术后发生Ⅱ型内漏的保护因素,IMA通畅情况、IMA开口直径和LA数量均是AAA患者EVAR术后发生Ⅱ型内漏的独立危险因素(P﹤0.05)。预测模型的C-index为0.824(95%CI:0.718~0.930),校准后的C-index为0.812(95%CI:0.710~0.914)。ROC曲线下面积为0.824;模型校准曲线显示模型预测曲线与预期曲线的重合性较好;临床决策曲线表明,若截断值为7%~99%,则该模型的临床有效性较好。结论吸烟史、IMA通畅情况、IMA开口直径和LA数量均是AAA患者EVAR术后发生Ⅱ型内漏的影响因素,根据各个影响因素所构建的预测模型的准确性较好,可用于预测AAA患者EVAR术后Ⅱ型内漏的发生风险。Objective To investigate the influencing factors for type II endoleak after abdominal aortic aneurysm(AAA)endovascular aneurysm repair(EVAR)and to establish a predictive model.Method The clinical data of 286 patients with AAA who received EVAR in the Provincial Hospital Affiliated to Shandong First Medical University during January 2018 to September 2022 were retrospectively analyzed.According to presence of type II endoleak during the postoperative follow-up period,the patients were separated into the control group(n=210)and the type II endoleak group(n=76).The clinical features,hematology indexes,AAA anatomy and operation were compared between the two groups.The factors affecting the occurrence of type II endoleak after EVAR in AAA patients were analyzed,the predictive model was constructed,the nomogram was drawn,and the calibration curve of the model was plotted,the concordance index(C-index)was calculated,and the receiver operating characteristic(ROC)curve and clinical decision curve were drawn to verify the accuracy and clinical effectiveness of the prediction model.Result There were statistically significant differences in proportion of patients with smoking history,diameter of inferior mesenteric artery(IMA)opening,number of lumbar artery(LA)and patency of IMA between the two groups(P<0.05).Multivariate analysis showed that smoking history was a protective factor for type II endoleak after EVAR in AAA patients,and IMA patency,diameter of IMA opening and LA number were independent risk factors for type II endoleak after EVAR in AAA patients(P<0.05).The C-index of the prediction model was 0.824(95%CI:0.718-0.930),and the calibrated C-index was 0.812(95%CI:0.710-0.914).The area under ROC curve was 0.824;the model calibration curve shows that the model prediction curve has good concordance with the expected curve.The clinical decision curve showed that if the cut-off value was between 7%and 99%,the clinical effectiveness of the model was good.Conclusion Smoke history,patency of IMA,diameter of IMA opening,and

关 键 词：腹主动脉瘤 腔内修复术 Ⅱ型内漏 影响因素 预测模型 

分 类 号：R543[医药卫生—心血管疾病]