CHA2DS2-VASc评分对下肢动脉硬化闭塞症患者介入治疗后复发风险的预测作用
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摘要
目的探讨CHA2DS2-VASc评分预测下肢动脉硬化闭塞症(ASO)患者介入治疗术后复发风险的作用。方法回顾性分析2011年1月至2015年6月接受介入治疗的394例下肢ASO患者临床资料,术后随访24个月。通过术后定期下肢动脉彩色超声和CTA检查观察患者术后血管通畅性情况,分析影响术后复发的危险因素。结果介入治疗术后2年复发率为41.1%(162/394)。CHA2DS2-VASc评分高危患者术后复发风险显著高于中危、低危组患者(P=0.006),评分升高与术后复发率较高相关(P<0.001)。单因素分析显示,糖尿病、高血压、手术方式、泛大西洋学会联盟(TASC)分型、CHA2DS2-VASc评分是术后复发影响因素;多因素Cox回归模型分析表明,糖尿病、TASC分型、CHA2DS2-VASc评分是术后复发独立危险因素。结论 CHA2DS2-VASc评分对下肢ASO患者介入治疗术后复发风险有较好的预测价值。
Objective To assess the value of CHA2DS2-VASc score in predicting the recurrence risk for patients with arteriosclerosis obliterans(ASO) of lower extremities after interventional therapy. Methods The clinical data of 394 patients with lower extremity ASO, who underwent interventional therapy during the period from January 2011 to June 2015, were retrospectively analyzed. The CHA2 DS2-VASc score was calculated for each patient. After the treatment, the patients were followed up for 24 months. The patency of lower extremity arteries was checked up periodically by color Doppler ultrasound and CT angiography, and the related factors that might induce recurrence were analyzed. Results The postoperative 2-year recurrence rate was 41.1%(162/394). The recurrent risk of patients with CHA2DS2-VASc score of high risk was significantly higher than that of patients with moderate risk score or low risk score(P =0.006). A striking parallel relationship existed between the increasing of CHA2DS2-VASc score and the incidence of postoperative recurrence(P<0.001). Univariate analysis indicated that diabetes, hypertension, surgical type,the typing of Transatlantic Society Coalition(TASC), and the CHA2DS2-VASc score were the influencing factors of postoperative recurrence. Multivariate Cox regression model analysis revealed that diabetes, TASC typing and CHA2DS2-VASc score were the independent risk factors for postoperative recurrence. Conclusion The CHA2DS2-VASc score has an excellent value in predicting the risk of recurrence in patients with ASO after interventional therapy.
Objective To assess the value of CHA2DS2-VASc score in predicting the recurrence risk for patients with arteriosclerosis obliterans(ASO) of lower extremities after interventional therapy. Methods The clinical data of 394 patients with lower extremity ASO, who underwent interventional therapy during the period from January 2011 to June 2015, were retrospectively analyzed. The CHA2 DS2-VASc score was calculated for each patient. After the treatment, the patients were followed up for 24 months. The patency of lower extremity arteries was checked up periodically by color Doppler ultrasound and CT angiography, and the related factors that might induce recurrence were analyzed. Results The postoperative 2-year recurrence rate was 41.1%(162/394). The recurrent risk of patients with CHA2DS2-VASc score of high risk was significantly higher than that of patients with moderate risk score or low risk score(P =0.006). A striking parallel relationship existed between the increasing of CHA2DS2-VASc score and the incidence of postoperative recurrence(P<0.001). Univariate analysis indicated that diabetes, hypertension, surgical type,the typing of Transatlantic Society Coalition(TASC), and the CHA2DS2-VASc score were the influencing factors of postoperative recurrence. Multivariate Cox regression model analysis revealed that diabetes, TASC typing and CHA2DS2-VASc score were the independent risk factors for postoperative recurrence. Conclusion The CHA2DS2-VASc score has an excellent value in predicting the risk of recurrence in patients with ASO after interventional therapy.
引文
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[11]January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRSguideline for the management of patients with atrial fibrillation:executive summary:a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society[J].Circulation,2014,130:2071-2104.
[12]Cairns JA.ACP journal club.CHA2DS2-VASc had better discrimination than CHADS2 for predicting risk for thromboembolism in atrial fibrillation[J].Ann Intern Med,2011,154:JC5-J13.
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[14]Gary T,Belaj K,Hafner F,et al.A high CHA2DS2-VASc score is associated with a high risk for critical limb ischemia in peripheral arterial occlusive disease patients[J].Atherosclerosis,2012,225:517-520.
[15]刘文导,冯柳迁,孟凡喆,等.下肢动脉硬化闭塞症介入治疗效果及影响术后复发因素分析[J].介入放射学杂志,2017,26:514-517.
[16]Champion S,Lefort Y,Gauzere BA,et al.CHADS2 and CHA2DS2-VASc scores can predict thromboembolic events after supraventricular arrhythmia in the critically ill patients[J].J Crit Care,2014,29:854-858.
[17]Dorenkamp M,Sohns C,Vollmann D,et al.Detection of left atrial thrombus during routine diagnostic work-up prior to pulmonary vein isolation for atrial fibrillation:role of transesophageal echocardiography and multidetector computed tomography[J].Int J Cardiol,2013,163:26-33.
[2]Scali ST,Rzucidlo EM,Bjerke AA,et al.Long-term results of open and endovascular revascularization of superficial femoral artery occlusive disease[J].J Vasc Surg,2011,54:714-721.
[3]Lip GY,Nieuwlaat R,Pisters R,et al.Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach:the euro heart survey on atrial fibrillation[J].Chest,2010,137:263-272.
[4]Cetin M,Cakici M,Zencir C,et al.Prediction of coronary artery disease severity using CHADS2 and CHA2DS2-VASc scores and a newly defined CHA2DS2-VASc-HS score[J].Am JCardiol,2014,113:950-956.
[5]中华医学会外科学分会血管外科学组.下肢动脉硬化性闭塞症治疗指南[J].中国实用外科杂志,2008,28:923-924.
[6]Rozenbaum Z,Elis A,Shuvy M,et al.CHA2DS2-VASc score and clinical outcomes of patients with acute coronary syndrome[J].Eur J Intern Med,2016,36:57-61.
[7]王洪剑,邓钢,秦永林,等.球囊扩张或(和)支架植入术治疗股浅动脉狭窄或闭塞的中远期疗效[J].介入放射学杂志,2012,21:810-815.
[8]李杨,佟铸,谷涌泉.股浅动脉支架内再狭窄的危险因素研究进展[J].介入放射学杂志,2016,25:554-558.
[9]European Heart Rhythm Association,European Association for Cardio-Thoracic Surgery,Camm AJ,et al.Guidelines for the management of atrial fibrillation:the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology(ESC)[J].Eur Heart J,2010,32:2369-2429.
[10]Camm AJ,Lip GY,De Caterina R,et al.2012 focused update of the ESC guidelines for the management of atrial fibrillation:an update of the 2010 ESC guidelines for the management of atrial fibrillation.Developed with the special contribution of the European Heart Rhythm Association[J].Eur Heart J,2012,33:2719-2747.
[11]January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRSguideline for the management of patients with atrial fibrillation:executive summary:a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society[J].Circulation,2014,130:2071-2104.
[12]Cairns JA.ACP journal club.CHA2DS2-VASc had better discrimination than CHADS2 for predicting risk for thromboembolism in atrial fibrillation[J].Ann Intern Med,2011,154:JC5-J13.
[13]Wasmer K,Kobe J,Dechering D,et al.CHADS2 and CHA2DS2-VASc score of patients with atrial fibrillation or flutter and newly detected left atrial thrombus[J].Clin Res Cardiol,2013,102:139-144.
[14]Gary T,Belaj K,Hafner F,et al.A high CHA2DS2-VASc score is associated with a high risk for critical limb ischemia in peripheral arterial occlusive disease patients[J].Atherosclerosis,2012,225:517-520.
[15]刘文导,冯柳迁,孟凡喆,等.下肢动脉硬化闭塞症介入治疗效果及影响术后复发因素分析[J].介入放射学杂志,2017,26:514-517.
[16]Champion S,Lefort Y,Gauzere BA,et al.CHADS2 and CHA2DS2-VASc scores can predict thromboembolic events after supraventricular arrhythmia in the critically ill patients[J].J Crit Care,2014,29:854-858.
[17]Dorenkamp M,Sohns C,Vollmann D,et al.Detection of left atrial thrombus during routine diagnostic work-up prior to pulmonary vein isolation for atrial fibrillation:role of transesophageal echocardiography and multidetector computed tomography[J].Int J Cardiol,2013,163:26-33.