局解手术学杂志2026，Vol.35Issue(6)：513-517,5.DOI:10.11659/jjssx.11E025110
Stanford B型主动脉夹层术后主动脉重塑不良的影响因素与列线图模型
Influencing factors and a nomogram model for poor aortic remodeling after thoracic endovascular aortic repair in patients with Stanford type B aortic dissection
摘要
Abstract
Objective To explore the influencing factors for poor aortic remodeling after thoracic endovascular aortic repair(TEVAR)in patients with Stanford type B aortic dissection(TBAD),and to construct a nomogram prediction model.Methods A total of 260 TBAD patients who underwent TEVAR in our hospital from January 2020 to January 2025 were divided into the model set(n=182)and the validation set(n=78)by random number table method.Patients in the model set were divided into the good remodeling group(n=122)and the poor remodeling group(n=60)according to the aortic remodeling situation at 3 months after surgery.Multivariate Logistic regression analysis was performed to identify the influencing factors for poor aortic remodeling after TEVAR in TBAD patients,and the nomogram risk prediction model was constructed.The predictive discrimination and consistency of the model were evaluated by receiver operating characteristic(ROC)curve and calibration curve,respectively.Results The follow-up results showed that the incidence of poor aortic remodeling after TEVAR in 260 patients with TBAD was 31.15%.There were statistically significant differences between the good remodeling group and the poor remodeling group in terms of the aortic arch length,the number of tears,the diameter of the false lumen,the false lumen branch perfusion,the time from onset to surgery,and platelet count(PLT)level(P<0.05).Multivariate Logistic regression analysis showed that increased aortic arch length(OR=0.807)and higher PLT level(OR=0.945)were the protective factors for poor aortic remodeling after TEVAR(P<0.05),while the number of tears≥3(OR=3.528),the larger diameter of the false lumen(OR=1.492),false lumen branch perfusion(OR=4.021),and the longer time from onset to surgery(OR=2.094)were the risk factors for poor aortic remodeling after TEVAR(P<0.05).In the ROC analysis,the area under the curve(AUC)of the model set and the validation set were 0.933(95%CI:0.899～0.967)and 0.948(95%CI:0.904～0.992),respectively.The Hosmer-Lemeshow test showed χ2=2.490,P=0.962 in the model set,and χ2=5.265,P=0.741 in the validation set.Conclusion The poor aortic remodeling after TEVAR in patients with TBAD is closely related to the aortic arch length,the number of tears,the diameter of the false lumen,the false lumen branch perfusion,the time from onset to surgery,and PLT level.The nomogram model constructed based on the above six factors has a high efficacy in predicting the risk of poor aortic remodeling after TEVAR.关键词
Stanford B型主动脉夹层/胸主动脉腔内修复术/主动脉重塑不良/影响因素/列线图Key words
Stanford type B aortic dissection/thoracic endovascular aortic repair/poor aortic remodeling/influencing factors/nomogram分类
医药卫生引用本文复制引用
张波,王同建,梁家立,张勇,任超..Stanford B型主动脉夹层术后主动脉重塑不良的影响因素与列线图模型[J].局解手术学杂志,2026,35(6):513-517,5.基金项目
济南市科技计划项目(202134002) （202134002）
山东第二医科大学附属医院科技发展项目(2023FYM098) （2023FYM098）
