气管支架置入患者的预后相关因素分析

Prognostic Risk Factors for Patients Receiving Airway Stent Placement

背景与目的气管支架被用于治疗各种良恶性气管疾病以及医源性操作引起的中央气道狭窄或气管瘘,其在迅速缓解症状方面具有较好的效果,但患者的长期生存仍有赖于对原发病的个体化治疗。因此,探索影响气管支架置入患者预后的相关危险因素,对于优化支架置入术以及改善患者的个体化临床管理具有帮助作用。方法回顾性研究2014年1月-2017年6月在浙江大学附属第一医院胸外科接受支气管镜下气管支架置入治疗的66例患者,分析年龄、性别、基础Charlson合并症指数(Charlson comorbidity index,CCI)、支架植入操作时长等临床指标对患者预后的影响。结果年龄、性别对患者预后没有显著影响,而CCI评分较高(P=0.045)和操作时间超过60 min(P=0.037)均为患者预后不良的独立危险因素,随后依据CCI评分和操作时长两个指标构建了患者预后的列线图预测模型,模型的受试者工作特征曲线(receiver operating characteristic curve,ROC)的曲线下面积为0.71,一致性指数为0.69。结论对于接受气管支架置入的患者,其基础的CCI评分和支架置入操作的时长对其预后判断具有一定的临床价值。

Background and objective Airway stents are used to treat central airway stenosis or tracheal fistula caused by a variety of malignant and benign tracheal diseases as well as iatrogenic procedures.Airway stent placement has a satisfying effect in instantly relieving of symptoms,but the long-term survival of patients still depends on the individualized treatment of the primary diseases.Therefore,exploring the prognostic risk factors of patients who received airway stent place-ment can be beneficial to the optimization of the placement procedure and also the improvement of individualized clinical management of patients.Methods Data of a total of 66 patients who underwent airway stent placement at the First Affiliated Hospital of Zhejiang University from January 2014 to June 2017 were retrospectively collected.Prognostic effects of the clini-cal characteristics as age,gender,Charlson comorbidity index(CCI)and procedure duration were analyzed.Results Age and gender had no significant effect on the outcomes of the patients,while higher CCI(P=0.045)and procedure duration over 60 min(P=0.037)were both independent risk factors of poor prognosis.A prognostic nomogram was then constructed,of which the area under the curve of the receiver operating characteristic(ROC)curve and the concordance index(C-index)was 0.71 and 0.69,respectively.Conclusion For patients receiving airway stent placement,the baseline CCI and the procedure duration had prognostic significance in clinical practice.