主动脉夹层修复术后死亡危险因素探究及死亡预测模型构建

doi:10.3969/j.issn.1006-6233.2025.04.019

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摘要 目的: 探讨影响stanford A型急性主动脉夹层(ATAAD)患者术后死亡的危险因素并构建列线图预测模型。方法: 回顾性分析2019年1月至2022年12月期间在南京医科大学第一附属医院接受手术治疗的245例ATAAD患者,确定随访时间最长为65个月。记录患者临床资料,根据随访期间患者是否死亡分为存活组和死亡组。采用COX比例风险模型筛选潜在的预后因素,并构建列线图预测模型,通过校准曲线和受试者工作特征曲线分析该模型的预测价值。结果: 随访结束后,死亡组46例(18.77%),存活组199例(81.22%)。死亡组病人死亡时间中位数为29个月(随访时间范围是0-65月);在单因素分析中,筛选出22个变量与ATAAD患者术后死亡有关(P<0.05);通过多元COX比例风险回归校正,只有严重主动脉瓣关闭不全(AI)、肠系膜缺血、脑缺血、新发卒中及白细胞计数(WBC)≥11.59×10⁹L^-1与ATAAD患者术后死亡风险增加有关(P<0.05)。基于这5项变量构建列线图预测模型,C-index=0.817,P<0.001。校准曲线显示,该模型预测值与实际值具有较好的一致性。经时间依赖性受试者工作特征曲线显示,该模型无论是对于1年、3年还是5年的死亡风险时,都显示出较好的临床区分度(曲线下面积均>0.7)。结论: 存在严重AI、肠系膜缺血、脑缺血、术后新发卒中及术前WBC过高都与ATAAD患者术后死亡风险独立相关,通过列线图证明以这五个变量构建预测死亡的模型是可行的。

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关键词 ：主动脉夹层, stanford A型, 死亡, 预测模型, 列线图

Abstract：Objective: To explore the risk factors affecting postoperative mortality in patients with Stanford type A acute aortic dissection (ATAAD) and to construct a nomogram prediction model. Methods: A retrospective analysis was conducted on 245 ATAAD patients who underwent surgical treatment at the First Affiliated Hospital with Nanjing Medical University from January 2019 to December 2022,with a maximum follow-up period of 65 months.Clinical data were recorded,and patients were divided into a survival group and a death group based on mortality during follow-up.The COX proportional hazards model was used to screen potential prognostic factors,and a nomogram prediction model was constructed.The predictive value of the model was analyzed using calibration curves and receiver operating characteristic (ROC) curves. Results: After follow-up,46 patients (18.77%) died,and 199 patients (81.22%) survived.The median time to death in the death group was 29 months (follow-up range:0–65 months).Univariate analysis identified 22 variables associated with postoperative mortality in ATAAD patients (P<0.05).After multivariate COX proportional hazards regression analysis,severe aortic valve insufficiency (AI),mesenteric ischemia,cerebral ischemia,postoperative new stroke,and a white blood cell count (WBC) ≥11.59×10<suP>9</suP>/L were independently associated with increased postoperative mortality risk (P<0.05).A nomogram prediction model was constructed based on these five variables,with a C-index of 0.817 (P<0.001).Calibration curves showed good agreement between predicted and actual values.Time-dependent ROC curves demonstrated that the model had good clinical discrimination for 1-year,3-year,and 5-year mortality risks (areas under the curve >0.7). Conclusion: Severe AI,mesenteric ischemia,cerebral ischemia,postoperative new stroke,and high preoperative WBC are independently associated with postoperative mortality risk in ATAAD patients.The nomogram model constructed using these five variables is feasible for predicting mortality.

Key words： Aortic dissection Stanford type A Death Predictive modeling Nomograms

基金资助:国家自然科学基金资助项目,(编号:82200340)

通讯作者: 王晓凤

引用本文:

宋颖, 李明辉, 郭垚钧, 沈沉, 王晓凤. 主动脉夹层修复术后死亡危险因素探究及死亡预测模型构建[J]. 河北医学, 2025, 31(4): 642-647.
SONG Ying, LI Minghui, GUO Yaojun, et al. Exploration of Risk Factors for Death after Aortic Dissection Repair and Construction of a Mortality Prediction Model. HeBei Med, 2025, 31(4): 642-647.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.04.019 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I4/642

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