2025 年第 7 期 第 20 卷

心脏瓣膜病患者主动脉瓣膜置换术中瓣膜材质的选择及预后预警因素分析

Selection of valve material and analysis of prognostic warning factors in patients with valvular heart disease undergoing aortic valve replacement

作者：刘正阿布都赛米·艾尼霍强朱涛俞国军阿布都乃比·麦麦提艾力

英文作者：Liu Zheng Abudusaimi Aini Huo Qiang Zhu Tao Yu Guojun Abudunaibi Maimaitiaili

单位：新疆医科大学第一附属医院心脏外科，乌鲁木齐830000

英文单位：Department of Cardiac Surgery The First Affiliated Hospital of Xinjiang Medical University Urumqi 830000 China

关键词：心脏瓣膜病；主动脉瓣膜置换术；瓣膜材质；预后；预警因素

英文关键词：Valvularheartdisease;Aorticvalvereplacementsurgery;Valvematerial;Prognosis;Warningfactors

• 摘要：

• 目的 探讨心脏瓣膜病（VHD）患者在主动脉瓣膜置换术（AVR）中瓣膜材质的选择以及对预后预警因素进行分析。方法 回顾性选取2022年8月至2024年6月于新疆医科大学第一附属医院行AVR治疗的VHD患者300例为研究对象，依据患者所置换瓣膜的不同材质，将其分为生物瓣膜组（121例）与机械瓣膜组（179例）。分析2组心功能、心肌重构、心肌损伤及炎症指标等临床资料，并比较2组不良事件发生情况。分析患者预后不良的独立危险因素。结果 术后当天、术后6个月时，生物瓣膜组的左心室舒张末期内径、左心室收缩末期内径、左心房内径、B型脑钠肽（BNP）、内脂素、基质金属蛋白酶9（MMP-9）、N末端B型脑钠肽前体（NT-proBNP）、白细胞介素6（IL-6）、C反应蛋白（CRP）、肿瘤坏死因子α、心肌肌钙蛋白I、肌酸激酶水平小于/低于机械瓣膜组，左心室射血分数（LVEF）、每搏输出量、心脏指数、IL-10水平高于/大于机械瓣膜组（均P＜0.05）。与机械瓣膜组比较，生物瓣膜组患者不良事件的总风险显著降低（相对危险度=4.302，95%置信区间：1.982～8.549，P＜0.05）。NT-proBNP、瓣膜材质、BNP、CRP、MMP-9以及LVEF是VHD患者预后不良的独立危险因素（比值比=2.099、2.587、1.828、2.168、1.795、2.699，均P＜0.05）。结论 NT-proBNP、瓣膜材质、BNP、CRP、MMP-9以及LVEF是VHD患者预后不良的独立危险因素。相较于机械瓣膜，生物瓣膜在心功能改善、心肌重构优化、减轻机体炎性应激反应及心肌损伤程度方面展现出更为显著的优势，并且能有效降低不良事件发生率。

• Objective  To explore the selection of valve material and analysis of prognostic warning factors in patients with valvular heart disease (VHD) undergoing aortic valve replacement surgery (AVR). Methods A total of 300 patients with VHD who underwent AVR in the First Affiliated Hospital of Xinjiang Medical University from August 2022 to June 2024 were retrospectively selected as the research objects. The patients were divided into biological valve group (121 cases) and mechanical valve group (179 cases) according to the different materials of the valve. The clinical data of cardiac function, myocardial remodeling, myocardial injury and inflammatory indicators were analyzed, and the incidence of adverse events was compared between the two groups. The independent risk factors of poor prognosis were analyzed. Results On the day after surgery and 6 months post-surgery, the levels of left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left atrial diameter, brain natriuretic peptide (BNP), visfatin, matrix metalloproteinase 9 (MMP-9), N-terminal pro-BNP (NT-proBNP), interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor α, cardiac troponin I, and creatine kinase in the biological valve group were less than/lower than those in the mechanical valve group; the levels of left ventricular ejection fraction (LVEF), stroke volume, cardiac index and IL-10 in the biological valve group were higher/greater than those in the mechanical valve group (all P＜0.05). Compared with the mechanical valve group, the total risk of adverse events of patients in biological valve group was significantly reduced (relative risk=4.302, 95% confidence interval: 1.982-8.549, P＜0.05). NT-proBNP, valve material, BNP, CRP, MMP-9 and LVEF were independent risk factors for poor prognosis in patients with VHD (odds ratio=2.099, 2.587, 1.828, 2.168, 1.795, 2.699, all P＜0.05). Conclusion NT-proBNP, valve material, BNP, CRP, MMP-9 and LVEF are independent risk factors for poor prognosis of VHD. Compared with mechanical valves, biological valves show more significant advantages in the improvement of cardiac function, optimization of myocardial remodeling, reduction of inflammatory stress response and myocardial injury, and can effectively reduce the incidence of adverse events.