血清纤维蛋白原、D-二聚体水平对腹主动脉瘤患者腔内修复术后发生髂支闭塞的预测价值

Predictive value of serum fibrinogen and D-dimer levels in iliac branch occlusion after endovascular repair of abdominal aortic aneurysm

目的探讨血清纤维蛋白原(FIB)、D-二聚体(D-D)水平在腹主动脉瘤(AAA)患者腔内修复术(EVAR)术后发生髂支闭塞中的预测价值。方法收集2020年1月至2021年12月于潍坊医学院附属医院行EVAR治疗的130例AAA患者的临床资料,根据术后是否发生髂支闭塞将其分为发生组(n=60)和未发生组(n=70),使用倾向性评分匹配法得到组间协变量均衡的样本,最终每组50例。统计患者术前血清FIB、D-D、甘油三酯(TG)等实验室指标,采用受试者工作特征(ROC)曲线下面积(AUC)、决策曲线分析血清FIB、D-D预测AAA患者EVAR术后发生髂支闭塞的价值。结果发生组患者的TG、FIB、D-D水平均高于未发生组患者,差异均有统计学意义(P﹤0.05)。Logistic回归模型分析结果显示,TG、FIB、D-D水平升高均是AAA患者EVAR术后发生髂支闭塞的危险因素(P﹤0.05)。术前血清FIB、D-D水平联合预测AAA患者EVAR术后发生髂支闭塞的AUC最大,预测价值最高。决策曲线分析结果显示,当高风险阈值为0.18~0.41、0.51~0.72、0.89~0.99时,血清FIB联合D-D的预测模型预测AAA患者EVAR术后发生髂支闭塞的净收益率优于血清FIB、D-D单独检测。结论术前血清FIB、D-D水平可用于预测AAA患者EVAR术后发生髂支闭塞,且预测价值较高。

Objective To investigate the predictive value of serum fibrinogen(FIB)and D-dimer(D-D)levels in the occurrence of iliac branch occlusion in patients with abdominal aortic aneurysm(AAA)after endovascular repair(EVAR).Method The clinical data of 130 patients with AAA who underwent EVAR in the Affiliated Hospital of Weifang Medical University from January 2020 to December 2021 were collected.According to whether iliac branch occlusion occurred after the operation,they were divided into occurrence group(n=60)and non-occurrence group(n=70).The propensity score matching method was used to obtain samples with balanced covariates between groups,finally 50 cases in each group.The preoperative serum FIB,D-D,triglyceride(TG),and other laboratory indicators of the patients were counted.The receiver operating characteristic(ROC)area under the curve(AUC)and decision curve were used to analyze the value of serum FIB and D-D in predicting the occurrence of iliac branch occlusion in patients with AAA after EVAR.Result The levels of TG,FIB,and D-D in the occurrence group were higher than those in the non-occurrence group,the differences were statistically significant(P<0.05).Logistic regression model analysis showed that up-regulation of TG,FIB,and D-D were risk factors for iliac branch occlusion after EVAR in AAA patients(P<0.05).The combination of preoperative serum FIB and D-D levels in predicting iliac branch occlusion after EVAR in AAA patients had the largest AUC and the highest predictive value.The results of decision curve analysis showed that when the high risk thresholds were 0.18-0.41,0.51-0.72,and 0.89-0.99,the predictive model of serum FIB combined with D-D was superior to the single detection of serum FIB and D-D in predicting the net return rate of iliac branch occlusion in AAA patients after EVAR.Conclusion Preoperative serum FIB and D-D levels could be used to predict iliac branch occlusion after EVAR in AAA patients,and have a high predictive value.