腹主动脉瘤进展相关危险因素分析

Analysis of risk factors associated with progression of abdominal aortic aneurysm

目的比较腹主动脉瘤(AAA)进展与无进展患者的临床与影像学特征,分析AAA进展的相关危险因素。方法连续筛选自2015年1月1日至2022年12月31日就诊于北部战区总医院且至少接受2次主动脉计算机断层扫描血管造影检查的151例AAA患者为研究对象。根据AAA的进展速度将患者分为无进展组(进展速度<0.5 mm/y,n=58)与进展组(进展速度≥0.5 mm/y,n=93)。分析两组患者的基线临床数据、实验室指标、影像学相关数据及随访结果。应用多因素Logistic回归分析AAA进展的相关危险因素,应用受试者工作特征(ROC)曲线分析相关危险因素对AAA进展风险的预测能力。利用ROC曲线所得出的截断值将所有患者分为两组,比较两组患者的AAA进展速度。根据是否合并相关危险因素对AAA直径≥截断值患者的进展速度进行比较。结果进展组中吸烟患者的比例显著高于无进展组,组间比较,差异有统计学意义(P<0.05)。进展组瘤体AAA最大直径、AAA进展速度均显著快于无进展组,AAA合并腔内血栓(ILT)、合并大量ILT、合并髂动脉动脉瘤、合并髂总动脉血栓患者的比例显著高于无进展组,组间比较,差异均有统计学意义(P<0.05)。多因素Logistic回归显示,吸烟(比值比=3.557,95%可信区间:1.448~8.740,P=0.006)、AAA最大直径(比值比=1.148,95%可信区间:1.076~1.226,P<0.001)、AAA合并ILT(比值比=3.183,95%可信区间:1.165~8.696,P=0.024)、合并髂总动脉血栓(比值比=2.938,95%可信区间1.178~7.328,P=0.021)是AAA进展的独立危险因素。ROC曲线分析结果显示,AAA最大直径有较好的预测AAA进展的效能(曲线下面积=0.750;95%可信区间:0.672~0.828);AAA最大直径截断值为43.55 mm,敏感度为52.7%,特异度为89.7%。直径≥43.55 mm的AAA患者进展速度显著大于直径<43.55 mm的AAA患者,差异有统计学意义(P<0.05)。AAA直径≥43.55 mm的患者的进展速度分析结果显示,吸烟、AAA合并ILT或合并髂总动脉血栓患者的AAA进展速度均更快。结论吸烟、AAA瘤体最大直径、AAA合并ILT及合并髂总动脉血栓是AAA进展的相关危险因素。AAA瘤体最大直径≥43.55 mm有较好的预测AAA进展的效能。AAA直径≥43.55 mm、吸烟、合并ILT或髂总动脉血栓的患者AAA进展速度更快。

Objective To analyze the risk factors for the progression of abdominal aortic aneurysm(AAA)by comparing the clinical and imaging characteristics of patients with progression and no progression AAA.Methods A total of 151 AAA patients admitted to the General Hospital of Northern Theater Command from January 1,2015 to December 31,2022 who had received at least two aortic computed tomography angiography were selected as subjects.According to the progression rate of AAA,patients were divided into a non-progression group(progression rate<0.5 mm/y,n=58)and a progression group(progression rate≥0.5 mm/y,n=93).Baseline clinical data,laboratory indicators,imaging data and follow-up results of the two groups were analyzed.Multivariate Logistic regression was used to analyze the risk factors for AAA progression,and receiver operating characteristic(ROC)curve was used to analyze the predictive ability of risk factors for AAA progression.All patients were divided into two groups using the cut-off value of the ROC curve,and the rate of AAA progression between the two groups was compared.Progression rates in patients with AAA≥truncated diameter were compared according to whether associated risk factors were present.Results The proportion of smoking patients in the progressive group was significantly higher than that in the non-progressive group,and the difference between groups was statistically significant(P<0.05).The maximum diameter and progression rate of AAA in the progressive group were significantly higher than those in the non-progressive group,and the proportions of AAA patients with intracavitary thrombus(ILT),a large number of ILT,iliac artery aneurysm,and common iliac artery thrombosis were significantly higher than those in the non-progressive group,with statistical significance between groups(P<0.05).Multivariate Logistic regression showed that smoking(odds ratio=3.557,95%confidence interval:1.448-8.740,P=0.006),maximum diameter of AAA(odds ratio=1.148,95%confidence interval:1.076-1.226,P<0.001),AAA combined with ILT(odds ratio=3.183,95%confidence interval:1.165-8.696,P=0.024)and common iliac artery thrombosis(odds ratio=2.938,95%confidence interval 1.178-7.328,P=0.021)were independent risk factors for AAA progression.The R0C curve analysis results showed that the maximum diameter of AAA had a better ability to predict the progress of AAA(area under the curve=0.750,95%confidence interval:0.672-0.828).The maximum diameter truncation value of AAA was 43.55 millimeters,the sensitivity was 52.7%,and the specificity was 89.7%.The progression rate of AAA patients with diameter≥43.55 millimeters was significantly higher than that of those with diamete<43.55 millimeters,and the difference was statistically significant(P<0.05).The rate of progression analysis in patients with AAA≥43.55 millimeters showed that the rate of progression was greater in patients who smoked,had AAA combined with ILT,or had common iliac artery thrombosis.Conclusion Smoking,maximum AAA diameter,combined with ILT and combined with common iliac artery thrombus were risk factors associated with the progression of AAA.The maximum diameter of AAA≥43.55 millimeters has a predictive effect on the progression of AAA.The rate of progression was higher in patients with AAA maximum diameter≥43.55 millimeters who smoked and combined with ILT or combined with common iliac artery thrombus.