Stanford B型主动脉夹层患者TEVAR术后发生不良事件的危险因素  

Risk Factors for Adverse Events in Stanford Type B Aortic Dissection After TEVAR Surgery

作　　者：刘雷[1] 法宪恩[1] 朱瑞 张宁[1] LIU Lei;FA Xianen;ZHU Rui;ZHANG Ning(Department of Cardiovascular Surgery,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第二附属医院心血管外科,河南郑州450000

出　　处：《河南医学研究》2025年第8期1351-1356,共6页Henan Medical Research

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190316);河南省科技厅科技攻关项目(222102310723)。

摘　　要：目的 分析Stanford B型主动脉夹层患者经胸主动脉腔内修复术(TEVAR)后发生不良事件的危险因素,并制作预测模型,指导临床医生预防TEVAR术后发生不良事件。方法 回顾性分析2018年1月至2023年7月于郑州大学第二附属医院就诊并接受TEVAR治疗的182例Stanford B型主动脉夹层患者,根据TEVAR术后是否发生急性脑梗死、重症感染等不良事件将182例患者分为不良事件组(38例)和完全康复组(144例)。比较两组间一般资料,将P<0.10的数据纳入多因素logistic分析,筛选出TEVAR术后发生不良事件的独立危险因素,并将对危险因素应用R 4.3.1软件绘制成列线图预测模型,应用受试者工作特征(ROC)曲线、校准曲线、DCA决策曲线等检验预测模型的预测效能。结果 多因素logistic回归分析中,可知白细胞计数、原发破口宽度及症状出现至接受TEVAR时间等为患者经TEVAR治疗术后发生不良事件的独立危险因素。应用R 4.3.1软件制作术后发生不良事件的列线图预测模型,ROC曲线下面积值为0.894(95%CI:0.845~0.943),预测模型区分度良好,而且优于不同独立危险因素单独预测TEVAR术后发生不良事件。校准曲线中模型开发集与理想模型贴近,说明预测模型性能良好。DCA决策曲线提示在风险阈值为0.03~1.0时,预测模型的净收益良好,说明在该区段临床实用价值更好。结论 白细胞计数增加、原发破口宽度增大、近端夹层累及2区及以上、症状出现至行TEVAR时间及复杂型Stanford B型主动脉夹层为Stanford B型主动脉夹层TEVAR术后发生不良事件的独立危险因素。由上述独立危险因素构建的临床模型预测性能良好,有一定的临床实用价值。Objective To analyze the risk factors for adverse events in patients with Stanford type B aortic dissection undergoing thoracic edovascular aortic repair(TEVAR),and develop a predictive model to guide clinical doctors in preventing adverse events after TEVAR surgery.Methods A retrospective analysis was conducted on 182 patients with Stanford type B aortic dissection who received TEVAR treatment at the Second Affiliated Hospital of Zhengzhou University from January 2018 to July 2023.Based on whether adverse events such as acute cerebral infarction and severe infection occurred after TEVAR surgery,the 182 patients were divided into adverse event group(38 cases)and complete rehabilitation group(144 cases).The general information between the two groups was compared,and data with P<0.10 were included in a multivariate logistic analysis to screen for independent risk factors for adverse events after TEVAR surgery.R 4.3.1 software was used to plot the risk factors into a column chart prediction model,and receiver operating characteristic(ROC)curve,calibration curve,DCA decision curve,and other tests were used to evaluate the predictive performance of the prediction model.Results In the multivariate logistic regression analysis,it was found that white blood cell count,primary rupture width,and time from symptom onset to TEVAR treatment were independent risk factors for adverse events after TEVAR treatment for patients.The R 4.3.1 software was used to create a column chart prediction model for adverse events after surgery.The area under the ROC curve value was 0.894(95%CI:0.845-0.943),and the prediction model had good discrimination and was superior to predicting adverse events after TEVAR treatment with different independent risk factors alone.The model development set in the calibration curve was close to the ideal model,indicating good performance of the predictive model.The DCA decision curve suggested that the net return of the prediction model was good when the risk threshold was between 0.03 and 1.0,indicating bett

关 键 词：Stanford B型主动脉夹层 胸主动脉腔内修复术 危险因素 预测模型 

分 类 号：R543.1[医药卫生—心血管疾病]