肾下型腹主动脉瘤腔内修复术后长期口服阿司匹林对瘤囊影响的倾向性评分匹配研究  

Effect of long-term aspirin treatment on aneurysm sac after endovascular aortic repair of infrarenal abdominal aortic aneurysms:a propensity score matched analysis

作　　者：王宜梅 季润 陈志鹏 张梦强 范海健[3] 蔡晶 乔彤 Wang Yimei;Ji Run;Chen Zhipeng;Zhang Mengqiang;Fan Haijian;Cai Jing;Qiao Tong(Department of Vascular Surgery,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Traditional Chinese Medicine,Nanjing 210008,China;Department of Vascular Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Imaging Department,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京中医药大学鼓楼临床医学院血管外科,南京210008 [2]南京大学医学院附属鼓楼医院血管外科,南京210008 [3]南京大学医学院附属鼓楼医院影像科,南京210008

出　　处：《中华外科杂志》2024年第10期960-966,共7页Chinese Journal of Surgery

基　　金：国家自然科学基金青年项目(82200543);江苏省卫生健康委医学科研项目(ZD2021056)。

摘　　要：目的探讨肾下型腹主动脉瘤行血管腔内修复术(EVAR)后长期口服阿司匹林对瘤囊扩张情况及持续性Ⅱ型内漏的影响。方法本研究为回顾性队列研究。回顾性分析2019年1月至2021年12月在南京大学医学院附属鼓楼医院血管外科接受EVAR治疗的133例肾下型腹主动脉瘤患者的临床资料。其中男性113例,女性20例,年龄(74.8±7.2)岁(范围:59~95岁)。根据患者术后是否长期规律服用阿司匹林,将其分为服用阿司匹林组(n=80)与未服用阿司匹林组(n=53)。采用倾向性评分匹配的方法对两组患者进行1∶1匹配,卡钳值为0.05。采用Kaplan-Meier法绘制两组患者主要终点事件(瘤囊扩大、发生持续性Ⅱ型内漏)和次要终点事件(不良心脑血管事件和临床相关出血事件)发生的累积概率曲线,并用Log-rank法进行比较。结果所有患者获得随访,随访时间(38.4±11.8)个月(范围:30~58个月)。133例患者中发生瘤囊扩大25例(18.8%),其中服用阿司匹林组20例,未服用阿司匹林组5例;Ⅱ型内漏35例(26.3%),其中服用阿司匹林组26例,未服用阿司匹林组9例。发生不良心血管事件11例(8.3%),临床相关出血事件5例。倾向性评分匹配后,两组均纳入32例患者。两组患者结局事件的累积概率曲线比较结果显示,服用阿司匹林组患者的瘤囊扩大率(Log-rank检验:P=0.010)、持续性Ⅱ型内漏发生率(Log-rank检验:P=0.019)均高于未接受阿司匹林组,差异有统计学意义。两组不良心血管事件和临床相关出血事件发生率的差异均无统计学意义(Log-rank检验:P值均>0.05)。结论血管腔内修复术后长期服用阿司匹林患者的瘤囊扩张率和持续性Ⅱ型内漏发生率高于未服用阿司匹林组,应在术前对该类患者的手术风险和获益进行全方面评估。Objective To investigate the effect of long-term oral aspirin on the changes in the aneurysm sac and persistent typeⅡendoleak after endovascular aortic repair(EVAR)of infrarenal abdominal aortic aneurysms based on propensity score-matched analysis.Methods A retrospective cohort study was used to analyze the clinical data of 133 patients with infrarenal abdominal aortic aneurysms treated with EVAR from January 2019 to December 2021 in the Department of Vascular Surgery,Nanjing Drum Tower Hospital.There were 113 males and 20 females,aged(74.8±7.2)years(range:59 to 95 years).Patients were divided into the group receiving aspirin(n=80)and the group not taking aspirin(n=53)based on whether they took aspirin regularly for a long time after surgery.The two groups were matched in a 1∶1 ratio using propensity score matching and the caliper value was 0.05.Cumulative probability curve was plotted using the Kaplan-Meier method and the Log-rank test was used to compare the differences in primary endpoint events(enlargement of the aneurysm sac,occurrence of persistent typeⅡendoleak)and secondary endpoint events(adverse cardiovascular events and clinically relevant bleeding events)between the two groups.Results The follow-up time was(38.4±11.8)months(range:30 to 58 months).Among the 133 patients,a total of 25 cases(18.8%)suffered enlargement of the aneurysm sac,including 20 cases in the group receiving aspirin and 5 cases in the group not taking aspirin;35 cases(26.3%)suffered persistent typeⅡendoleak,including 26 cases in the group receiving aspirin and 9 cases in the group not taking aspirin.Adverse cardiovascular events occurred in 11 cases(8.3%)and clinically relevant bleeding events were reported in 5 cases(3.8%).A matched cohort was established after propensity score matching,resulting in 32 cases per group.The survival analysis found that the rate of aneurysm sac enlargement was significantly higher in the group receiving aspirin than that in the group not taking aspirin(Log-rank test:P=0.010),and the incidence

关 键 词：主动脉瘤 腹 血管外科手术 腔内修复术 瘤囊扩张 Ⅱ型内漏 阿司匹林 

分 类 号：R654.3[医药卫生—外科学]