大动脉炎合并严重冠状动脉病变患者冠状动脉旁路移植术的预后分析  

The prognostic analysis of coronary artery bypass grafting in patients with Takayasu arteritis complicated by severe coronary artery lesions

作　　者：杜娟[1] 廖华[1] 张魁[2] 郑居兵[2] 李涛涛[1] 董然[2] 潘丽丽[1] DU Juan;LIAO Hua;ZHANG Kui;ZHENG Jubing;LI Taotao;DONG Ran;PAN Lili(Department of Rheumatology and Immunology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Veasses Diseases,Beijing100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所风湿免疫科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2025年第2期154-160,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(82270427);北京市自然科学基金(7232038);北京安贞医院国家心血管疾病临床医学研究中心高水平研究专项(2024AZC3005)。

摘　　要：目的:探讨CABG术在大动脉炎(Takayasu arteritis,TAK)患者中的治疗效果方法:回顾性纳入北京安贞医院14例大动脉炎因严重冠状动脉病变行CABG术治疗,通过CTA对桥血管进行随访,记录桥血管的通畅情况及主要心血管不良事件(major adverse cardiovascular events,MACE)。桥血管是否通畅和/或MACE分为两组比较差异,应用Kaplan-Meier曲线描绘CABG术后患者MACE事件发生率及影响因素。结果:14例大动脉炎患者13例为女性,1例为男性,平均年龄为(46.9±9.2)岁,中位病程为36.0(12.0,123.0)个月,影像学中位随访时间10.0(6.0,12.0)个月,术后MACE中位随访时间为18.5(5.3,49.8)个月,应用Kaplan-Meier曲线描绘CABG术后的MACE发生率,Log-rank分析变量差异性结果提示术后应用免疫抑制治疗(P=0.007)和术前术后均应用免疫抑制治疗(P=0.043)可明显降低术后的MACE发生率。结论:TAK合并严重冠状动脉病变患者术前术后规律应用免疫抑制治疗可降低MACE发生率,改善预后。Objective:To explore the therapeutic effects of CABG in patients with Takayasu arteritis(TAK).Methods:This retrospective study included 14 patients with Takayasu arteritis in Beijing Anzhen Hospital who underwent CABG for severe coronary artery disease.Coronary CT angiography(CTA)was used for follow-up to assess the patency of the bypass grafts and record major adverse cardiovascular events(MACE).Patients were divided into two groups based on graft patency and/or MACE occurrence,and the differences were compared.The Kaplan-Meier curve was used to analyze factors influencing MACE after CABG.Results:Among the 14 patients with TAK,13 were female and 1 was male,with a mean age of(46.9±9.2)years and an average disease duration of 36.0(12.0,123.0)months.The mean follow-up duration for imaging was 10.0(6.0,12.0)months,and the mean follow-up for MACE after surgery was 18.5(5.3,49.8)months.Kaplan-Meier curves were used to depict the incidence of MACE CABG.Log-rank analysis of variable differences indicated that postoperative immunosuppressive therapy(P=0.007)and combined preoperative and postoperative immunosuppressive therapy(P=0.043)significantly reduced the incidence of postoperative MACE.Conclusions:Regular immunosuppressive before and after surgery in patients with Takayasu arteritis combined with severe coronary artery lesions can reduce the incidence of MACE and improve prognosis.

关 键 词：大动脉炎 冠状动脉旁路移植术 冠状动脉CTA 主要心血管不良事件 

分 类 号：R54[医药卫生—心血管疾病]