冠心病搭桥患者腹主动脉超声筛查情况及影响因素分析

摘要/Abstract

摘要： 目的探究在冠心病搭桥患者中腹主动脉瘤的发生情况以及影响因素分析。方法前瞻性纳入2017年1月至2022年12月在泰达国际心血管病医院做冠脉搭桥手术并行腹主动脉瘤(abdominal aortic aneurysm, AAA)超声筛查1824例患者,查出AAA做为观察组(53例),未查出做为对照组(1771例),收集两组年龄、性别、BMI、吸烟史、高血压、糖尿病、高脂血症、心肌梗死病史、肾功能不全、冠脉病变支数及左主干病变等基线临床资料,应用t检验、χ²检、多因素 Logistic回归分析等统计学方法进行组间分析,P≤0.05为差异具有统计学意义。结果观察组中高龄(OR=1.063,95%CI 1.022-1.106,P=0.002)、男性(OR=3.714,95%CI 1.668-8.271,P=0.001)、吸烟史(OR=1.97,95%CI:1.126-3.446,P=0.017)、高血压(OR=1.654,95%CI:1.005-2.723,P=0.048)、心梗史(OR=2.768,95%CI:1.611-4.756,P<0.01)、肾功能不全(OR=4.754,95%CI:2.427-9.310,P<0.01)合并AAA发生率高于对照组,为独立危险因素。观察组糖尿病合并率(P=0.002)低于对照组,为独立保护因素(OR=0.412,95%CI:0.221-0.769,P=0.005)。差异均有统计学意义(P≤0.05)。两组BMI(P=0.557)、高脂血症(P=0.147)、冠脉病变支数(P=0.295)及左主干病变(P=0.917)指标比较,差异无统计学意义(P>0.05)。结论在冠心病搭桥患者中实行腹主动脉瘤超声筛查是可行的,男性、高龄、吸烟、高血压、心梗史、肾功能不全是AAA的高危因素,临床工作中应加强此类患者中AAA筛查以及指导。糖尿病是患AAA的保护因素,但仍需数据证实。

关键词: 腹主动脉瘤, 冠心病, 超声筛查, 危险因素

郭俊莹, 付鸿江, 韩立菊, 冯玉召, 孔宣柱, 赵福成, 李学东. 冠心病搭桥患者腹主动脉超声筛查情况及影响因素分析[J]. 心血管病防治知识, 2026, 16(7): 25-31.

参考文献

[1] Gavali H, Mani K, Furebring M, et al. Editor's Choice - Outcome of Radical Surgical Treatment of Abdominal Aortic Graft and Endograft Infections Comparing Extra-anatomic Bypass with In Situ Reconstruction: A Nationwide Multicentre Study[J]. Eur J Vasc Endovasc Surg,2021,62(6):918-926.
[2] Abreu JA, Nguyen TC. Commentary: Another important tool in the toolbox: The descending branch of the lateral circumflex femoral artery in coronary artery bypass grafting[J]. J Thorac Cardiovasc Surg, 2021, 161:1273-1274.
[3] Levin SR, Farber A, King EG, et al. Outcomes of axillofemoral bypass for intermittent claudication[J]. J Vasc Surg, 2022,75(5):1687-1694.
[4] Shutze WP Sr, Shutze R, Dhot P, et al. Sex as an independent risk factor for long-term survival after endovascular aneurysm repair[J]. J Vasc Surg, 2019,69(4):1080-1089.
[5] Ahmadov K, Sologashvili T, Roffi M, et al. A giant coronary artery aneurysm associated with multiple peripheral arterial aneurysms and an abdominal aortic aneurysm[J]. Eur J Cardiothorac Surg, 2018,54(3):598-600.
[6] Ge YP, Li CN, Cheng LJ, et al. One-Stage Repair of Adult Aortic Coarctation and Concomitant Cardiac Diseases: Ascending to Abdominal Aorta Extra-Anatomical Bypass Combined with Cardiac Surgery[J]. Heart Lung Circ, 2019,28(11):1740-1746.
[7] Wang X, Ma J, Dong X, et al. The anesthetic management of a patient undergoing simultaneous open abdominal aortic aneurysm repair and coronary artery bypass grafting: A case report[J]. Medicine (Baltimore), 2022,101(45):e31485.
[8] Koshty A, Bork M, Böning A, et al. Coronary Artery Disease as a Relevant Risk Factor in Screening of Abdominal Aortic Ectasia and Aneurysm[J]. Thorac Cardiovasc Surg, 2021,69(1):57-62.
[9] Khouzam MS, Khouzam N. Giant coronary artery aneurysms involving more than one coronary artery: case report[J]. J Cardiothorac Surg, 2021,16(1):177.
[10] Khan FM, Hameed I, Milojevic M, et al. Quality metrics in coronary artery bypass grafting[J]. Int J Surg, 2019,65:7-12.
[11] Ryer EJ, Garvin RP, Zhou Y, et al. Outcomes of familial abdominal aortic aneurysm repair in the Vascular Quality Initiative[J]. J Vasc Surg, 2019,69(3):717-727.
[12] Kaemmerer AS, Alkhalaileh K, Suleiman MN, et al. Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management[J]. J Cardiothorac Surg, 2023,18(1):60.
[13] Kim, E.S.H., et al., Sex Differences in Peripheral Vascular Disease: A Scientific Statement From the American Heart Association. Circulation, 2025. 151(14): e877-e904.
[14] Papadopoulos G, Kontopodis N, Marketou ME, et al. Analysis of Echocardiographic Markers and Pulse Wave Velocities in a Patient Who Developed New Cardiac Symptoms after Implantation of an Aortic Endograft[J]. Ann Vasc Surg, 2019,58:381.
[15] Skripochnik E, Ford B, Bilfinger TV, et al. Endovascular Repair of the Ascending Aorta for an Anastomotic Saphenous Vein Graft Aneurysm[J]. Ann Vasc Surg, 2020,64:412.
[16] Alkhawam H, Windish S, Abo-Salem E. Distal radial artery access among cases with radial artery occlusion for primary percutaneous intervention[J]. Future Cardiol, 2019,15(3):169-173.
[17] Liu Z, Li Y, Lin Y, et al. Aging aggravates aortic aneurysm and dissection via miR-1204-MYLK signaling axis in mice[J]. Nature communications, 2024,15(1):5985.
[18] Gaudino M, Benedetto U, Fremes S, et al. Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis[J]. JAMA, 2020,324(2):179-187.
[19] Tian M, Wang X, Sun H, et al. No-Touch Versus Conventional Vein Harvesting Techniques at 12 Months After Coronary Artery Bypass Grafting Surgery: Multicenter Randomized, Controlled Trial[J]. Circulation, 2021,144(14):1120-1129.
[20] Yu G, Chen P, Sun C, et al. The global burden of aortic aneurysm attributable to hypertension from 1990 to 2021: Current trends and projections for 2050[J]. PloS one, 2025,20(7):e327830.
[21] 张学慧,赵全明,陈雪,等.高血压对兔腹主动脉瘤进展过程及管壁炎症活动的影响[J].中华老年心脑血管病杂志,2019,21(7):745-749.
[22] Xiao Y, Xiang T. Association of cardiovascular disease and urate levels with aortic aneurysm: a bilateral mendelian randomization study[J]. Scientific reports, 2024,14(1):24070.
[23] van Knippenberg S E M, Thiermann N J S, Atazadah M, et al. Assessing Cardiovascular Risk and Medication Management in Patients with Abdominal Aortic Aneurysm across Three Decades[J]. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2025,70(1):46-52.
[24] Goeddel LA, Colao J, Choi CW, et al. Comparison of Outcomes Following Coronary Artery Bypass Grafting With Arterial Versus Venous Conduits[J]. J Cardiothorac Vasc Anesth, 2022,36(2):599-607.
[25] de Waard D, Fagan A, Minnaar C, et al. Management of patients after coronary artery bypass grafting surgery: a guide for primary care practitioners[J]. CMAJ, 2021,193(19):E689-E694.
[26] Takagi H, Umemoto T. Negative association of diabetes with rupture of abdominal aortic aneurysm. Diab Vasc Dis Res[J]. 2016,13(5):341-347.
[27] Dattani N, Sayers RD, Bown MJ. Diabetes mellitus and abdominal aortic aneurysms: A review of the mechanisms underlying the negative relationship[J]. Diab Vasc Dis Res, 2018,15(5):367-374.