| 李锐东,李承志,张艳,王晓白,李王海.数字减影血管造影iFlow技术预测急性下肢缺血患者接受血运重建术后30天内大截肢事件[J].中国医学影像技术,2025,41(1):74~78 |
| 数字减影血管造影iFlow技术预测急性下肢缺血患者接受血运重建术后30天内大截肢事件 |
| Digital subtraction angiography iFlow technology for predicting major amputation in acute lower limb ischemia patients within 30 days after revascularization operation |
| 投稿时间：2024-07-22 修订日期：2024-12-09 |
| DOI：10.13929/j.issn.1003-3289.2025.01.016 |
| 中文关键词: 缺血 下肢 截肢术,外科性 血管造影术,数字减影 |
| 英文关键词:ischemia lower extremity amputation, surgical angiography, digital subtraction |
| 基金项目:广东省中医药局科研项目(20242018)。 |
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| 中文摘要: |
| 目的 观察数字减影血管造影(DSA)iFlow技术用于预测急性下肢缺血(ALLI)患者接受血运重建术后30天内发生大截肢事件的价值。方法 回顾性纳入310例接受血运重建术ALLI患者,根据术后30天内接受大截肢手术与否将其分为大截肢组(n=36)与无大截肢组(n=274)。对血运重建后DSA图像进行后处理获得iFlow参数,包括达峰时间(TTP)和峰值(Peak);绘制受试者工作特征(ROC)曲线,获取TTP和Peak预测术后大截肢的最佳截断值并将其转换为二分类变量,与其他参数共同纳入多因素logistic回归分析,筛选可用于预测术后大截肢的独立因素。结果 大截肢组TTP高于、而Peak低于无大截肢组(P均＜0.05)。ROC曲线分析显示,以TTP及Peak预测术后30天内大截肢的曲线下面积(AUC)分别为0.831及0.712,其最佳截断值分别为16 s及1.53。多因素logistic回归分析结果显示,心房颤动(AF)[OR(95%CI)=3.048(1.076,8.632)]、皮肤花斑[OR(95%CI)=6.035(2.323,15.677)]、血运重建后TTP≥16 s[OR(95%CI)=8.414(3.116,22.723)]及术后48 h高肌红蛋白 [OR(95%CI)=1.001(1.001,1.001)]均为ALLI患者接受血运重建术后30天内发生大截肢事件的独立预测因子,而Peak二分类变量并非独立预测因子[OR(95%CI)=0.485(0.183,1.283),P=0.145]。结论 DSA iFlow参数中的TTP可用于预测接受血运重建术ALLI患者30天内发生大截肢。 |
| 英文摘要: |
| Objective To observe the value of digital subtraction angiography (DSA) iFlow parameters for predicting major amputation in patients with acute lower limb ischemia (ALLI) within 30 days after revascularization operation. Methods Totally 310 ALLI patients who underwent revascularization operation were retrospectively included and divided into major amputation group (n=36) and non-major amputation group (n=274) according to major amputation within 30 days after revascularization operation or not. iFlow parameters, including time to peak (TTP) and the Peak were obtained after processing of DSA images after revascularization. Receiver operating characteristic (ROC) curves were used to screen the optimal cut-off value of TTP and Peak for predicting major amputation post operation, and then TTP and Peak were dichotomized. The dichotomized TTP and Peak variables and other variables were admitted into a multivariate logistic regression to identify independent predictors of major amputation. Results TTP was higher and Peak was lower in major amputation group than those in non-major amputation group (both P＜0.05). ROC curve analysis showed that the area under the curve (AUC) of TTP and Peak for predicting major amputation within 30 days post operation was 0.831 and 0.712, respectively, and the optimal cut-off value was 16 s and 1.53, respectively. Multivariate logistic regression analysis revealed that atrial fibrillation (AF)[OR(95%CI)=3.048(1.076, 8.632)], livid skin appearance [OR(95%CI)=6.035(2.323, 15.677)], TTP≥16 s after revascularization operation [OR(95%CI)=8.414(3.116, 22.723)] and high myoglobin levels measured 48 h after operation [OR(95%CI)=1.001(1.001, 1.001)] were all independent predictors of major amputation within 30 days in ALLI patients, but dichotomized Peak variable was not an independent predictor [OR(95%CI)=0.485(0.183, 1.283),P=0.145]. Conclusion TTP obtained through DSA iFlow was valuable for predicting major amputation in ALLI patients within 30 days after revascularization operation. |
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