胸主动脉腔内修复术后预防性应用非甾体抗炎药发生植入后综合征患者的临床特征及相关因素分析

Analysis of clinical characteristics and related factors of patients with post-implantation syndrome following prophylactic application of non-steroidal anti-inflammatory drugs after thoracic endovascular aortic repair

摘要:

目的]探讨胸主动脉腔内修复术(TEVAR)后预防性应用非甾体抗炎药(NSAID)发生植入后综合征(PIS)患者的临床特征及相关因素。 [方法]回顾性连续纳入2013年9月—2024年4月期间于北部战区总医院接受TEVAR后预防性应用NSAID的患者510例。根据术后是否发生PIS分为PIS组(34例,占6.67%)和非PIS组(476例,占93.33%)。比较两组间一般资料、既往病史及手术特征等,采用单因素和多因素Logistic回归分析发生PIS的危险因素。应用ROC曲线分析评价各危险因素对PIS的检测效能。 [结果]对比PIS组和非PIS组患者的基线数据和临床特征,PIS组患者性别为男性、入院时胸背痛、入院时肢体缺血、入院时收缩压、住院期间应用血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)类药物、术前白细胞(WBC)计数、股动脉切开入路均较非PIS组增加,而年龄、术前估算的肾小球滤过率(eGFR)水平、住院期间应用他汀类药物较非PIS组降低,差异均有统计学意义。PIS组患者术后C反应蛋白水平、术后住院期间临床不良事件发生率和术后住院时长较非PIS组增加。术后30天随访,两组主动脉不良事件发生率差异无显著性(P＜0.05)。单因素和多因素Logistic回归分析发现,患者年龄＜60岁(OR＝4.1,5%CI:1.348～16.188,P＝0.015)、术前WBC计数增加(OR＝3.582,95%CI:1.469～8.735,P＝0.005)、股动脉切开入路(OR＝8.9,5%CI:1.849～37.610,P＝0.006)是PIS发生的独立危险因素。ROC曲线分析结果显示,患者年龄＜60岁、术前WBC计数增加、股动脉切开入路及三项联合预测TEVAR术后PIS发生的曲线下面积分别为0.653(95%CI:0.573～0.733)、0.686(95%CI:0.600～0.771)、0.699(95%CI:0.627～0.770)、0.826(95%CI:0.765～0.887)。 [结论]TEVAR术后预防性应用NSAID后仍有部分患者发生PIS。年龄＜60岁、术前WBC计数增加、股动脉切开入路是预防性用药后PIS发生的独立危险因素,且随着患者合并独立危险因素数目的增加,PIS发生率呈上升趋势。

Abstract:

Aim To investigate the clinical characteristics and related factors of post-implantation syndrome (PIS) following the prophylactic application of non-steroidal anti-inflammatory drugs (NSAID) after thoracic endovascular aortic repair (TEVAR). Methods A total of 510 adult patients who had received prophylactic NSAID after TEVAR at General Hospital of Northern Theater Command from September 2013 to April 2024 were consecutively included in the study. The patients were divided into two groups based on the occurrence of PIS postoperatively:the PIS group (34 patients, 6.67%) and the non-PIS group (476 patients, 93.33%). General information, past medical history and surgical features were compared between the two groups. Univariate and multivariate Logistic regression analysis were used to identify predictors of PIS. The ROC curve was used to assess the overall diagnostic performance of the risk factors. Results The baseline data and clinical characteristics of PIS group and non-PIS group were compared. The rate of gender as male, chest and back pain on adimission, limb ischaemia on admission, systolic blood pressure on admission, use of angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) drugs during hospitalization, preoperative white blood cell (WBC) count and surgical approach involving an incision in PIS group were higher than those in non-PIS group , and the age, preoperative estimated glomerular filtration rate (eGFR) level and use of statin drugs during hospitalization were lower than those in non-PIS group, all differences were statistically significant. Postoperative C-reactive protein level, incidence of clinical adverse events during postoperative hospitalization, and time of postoperative hospitalization were increased in PIS group compared with those in non-PIS group. There was no significant difference in the incidence of aortic adverse events between the two groups (P＜0.05). Univariate and multivariate Logistic regression analysis identified patients' age ＜ 60 years (OR＝4.1,5%CI:1.348~16.188, P＝0.015), increased preoperative WBC count (OR＝3.2,5%CI:1.469~8.735, P＝0.005), and surgical approach involving an incision (OR＝8.9,5%CI:1.849~37.610, P＝0.006) as independent predictors for PIS. The results of the ROC curve analysis showed that the area under the curve of patients' age ＜60 years, increased preoperative WBC count, femoral arteriotomy access, and the three combined diagnoses in predicting the occurrence of PIS after TEVAR were 0.653 (95%CI:0.573~0.733), 0.686(95%CI:0.600~0.771), 0.699(95%CI:0.627~0.770), 0.826(95%CI:0.765~0.887). Conclusion Despite the prophylactic use of NSAID, some patients develop PIS after TEVAR. Patients'age ＜ 60 years, elevated preoperative WBC count, and femoral artery incision approach are independent risk factors for PIS after preventive medication. Additionally, the incidence of PIS increased with the number of independent risk factors present.