基于倾向性评分匹配探讨覆膜支架腔内修复术对Stanford B型主动脉夹层动脉瘤的治疗效果和血清内皮素-1、血尿酸水平的影响OA

Objective To investigate the therapeutic effects of endovascular repair with covered stent graft on Stan-ford type B aortic dissection(AD)and its impact on serum endothelin-1(ET-1)and uric acid levels using propensity score matching(PSM).Methods From July 2021 to March 2024,a total of 160 patients with Stanford type B aortic dissection(AD)admitted to the Department of Cardiovascular Surgery at the Seventh People's Hospital of Zhengzhou were enrolled in this study.These patients were randomly divided into a study group and a control group using a random number table.The control group received conventional medical conservative treatment,while the study group received endovascular repair with a covered stent graft in addition to the treatment given to the control group.The clinical data of the two groups of patients were matched at a ratio of 1∶1,and ultimately,58 pairs of patients were successfully matched.The study compared the in-hospital mortality rate,the rate of reoperation or reintervention,and the incidence of complications between the two groups.Additional-ly,liver and kidney function,serum ET-1 and uric acid levels were assessed before and 2 weeks after treatment.The Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ)scores,SF-36 scale scores,and follow-up results were also com-pared between the two groups.Results There was no significant difference in in-hospital mortality rate and the rate of reop-eration or reintervention between the two groups(P＞0.05).However,the incidence of postoperative complications was higher in the study group than in the control group(x2=4.921,P=0.027).Compared with pre-treatment levels,post-treatment levels of ALT,AST,BUN,and SCr in the study group were decreased and were lower than those in the control group(t=9.296,14.561,4.473,11.468,P＜0.001).Similarly,post-treatment levels of ET-1 and serum uric acid in the study group were decreased and lower than those in the control group(t=5.182,7.411,P＜0.001).After treatment,APACHE Ⅱ scores were decreased and SF-36 scores were increased in both groups,with greater changes observed in the study group(t=5.898,7.982,4.525,P＜0.001).Follow-up results showed that the rates of reoperation or reintervention and mortality were lower in the study group than in the control group(x2=8.700,5.902,P=0.003,0.015).Conclusion The combination of medical treatment and endo-vascular repair with covered stent graft for Stanford type B AD patients can improve the quality of life,enhance liver and kid-ney function,reduce the incidence of complications and re-treatment,and improve the prognosis.The therapeutic effect is su-perior to that of medical treatment alone,and this may be related to the reduction in serum ET-1 and uric acid levels.