主动脉瓣狭窄患者经导管主动脉瓣置换术后发生血管并发症的危险因素分析  

Risk factors of vascular complications after transcatheter aortic valve implantation in patients with aortic stenosis

作　　者：马冬纹[1] 桂燚 蔡国强[1] 安国营[2] Ma Dongwen;Gui Yi;Cai Guoqiang;An Guoying(Department of Cardiology Intensive Care Medicine,the Affiliated Hospital of Jining Medical University,Jining 272000,China;Department of Cardiac Surgery,the Affiliated Hospital of Jining Medical University,Jining 272000,China)

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

出　　处：《中国医师杂志》2025年第1期86-90,共5页Journal of Chinese Physician

基　　金：济宁市重点研发计划项目(2022YXNS034)。

摘　　要：目的探讨主动脉瓣狭窄患者经导管主动脉瓣置换(TAVI)术后发生血管并发症的相关危险因素。方法回顾性纳入2018年1月—2023年6月济宁医学院附属医院收治的80例主动脉瓣狭窄患者作为研究对象。患者均接受TAVI术,按TAVI术后是否发生血管并发症(VC)分为VC组(13例,16.3%)和N-VC组(67例,83.7%)。比较两组患者术前基本特征、手术相关指标以及术前实验室指标;采用多因素logistic回归分析筛选出影响主动脉瓣狭窄患者TAVI术后发生VC的独立预测因素;并基于独立预测因素构建列线图模型,绘制列线图模型的校准曲线进行内部验证;绘制预测主动脉瓣狭窄患者TAVI术后发生VC的受试者工作特征(ROC)曲线,进一步分析联合预测模型的预测效能。结果VC组患者女性占比、合并糖尿病占比、平均跨瓣压差、血管壁钙化占比、经心尖手术路径占比、脑钠肽(BNP)以及肌酐均明显高于N-VC组,左室射血分数明显低于N-VC组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,性别、合并糖尿病、手术路径以及BNP为主动脉瓣狭窄患者TAVI术后发生VC的独立危险因素(均P<0.05)。基于4个独立危险因素构建预测主动脉瓣狭窄患者TAVI术后发生VC的列线图模型,校准曲线显示,主动脉瓣狭窄患者TAVI术后发生VC的预测值与实际观测值符合度良好(P>0.05)。ROC曲线分析结果显示,性别、合并糖尿病、手术路径以及BNP预测主动脉瓣狭窄患者TAVI术后发生VC的曲线下面积(AUC)分别为0.745、0.769、0.834以及0.857,联合预测的AUC为0.938。结论性别、年龄、手术路径以及BNP为主动脉瓣狭窄患者TAVI术后发生VC的独立预测因素,基于独立预测因素构建的列线图模型具有较高的预测价值。Objective To investigate the risk factors of vascular complications(VC)after transcatheter aortic valve implantation(TAVI)in patients with aortic stenosis.MethodsA total of 80 patients with aortic stenosis admitted to the Affiliated Hospital of Jining Medical University from January 2018 to June 2023 were retrospectively included as the study objects.All patients underwent TAVI surgery and were divided into VC group(13 cases,16.3%)and N-VC group(67 cases,83.7%)according to whether VC occurred after TAVI surgery.The preoperative basic characteristics,surgery-related indexes and preoperative laboratory indexes were compared between the two groups.Multivariate logistic regression analysis was used to screen out independent predictors of postoperative VC in patients with aortic stenosis after TAVI.Based on independent predictors,a nomogram model was constructed,and the calibration curve of the nomogram model was drawn for internal verification.Receiver operating characteristic(ROC)curves were drawn to predict VC after TAVI in patients with aortic stenosis,and the predictive efficacy of the combined prediction model was further analyzed.ResultsThe proportion of female patients,the proportion of diabetic patients,the mean cross-valve pressure difference,the proportion of vascular wall calcification,the proportion of transapical surgical routes,brain natriuretic peptide(BNP)and creatinine in VC group were significantly higher than those in the N-VC group,and the left ventricular ejection fraction was significantly lower than that in the N-VC group,with statistical significance(all P<0.05).Multivariate logistic regression analysis showed that gender,combined diabetes,surgical path and BNP were independent risk factors of postoperative VC in patients with TAVI(all P<0.05).Based on four independent risk factors,a nomogram model was constructed to predict the occurrence of VC after TAVI in patients with aortic stenosis.The calibration curve showed that the predicted value of VC after TAVI in patients with aortic stenosis wa

关 键 词：主动脉瓣狭窄 经导管主动脉瓣置换术 血管并发症 

分 类 号：R65[医药卫生—外科学]