基于指南的腹腔大动脉动脉瘤查显著表现不佳,可能受到医学并发症的影响
Rithva Ramesh1, Piper Stacey2, Melvin Alexander1
1School of Medicine, Albert Einstein College of Medicine, Bronx, NY.
Journal of vascular surgery
|October 30, 2025
概括
腹腔大动脉瘤 (AAA) 查率较低,但查有效降低了破裂风险. 医学并发症可能会影响查决策,在查的个体中,一些疾病更为普遍.
科学领域:
- 血管外科 血管外科
- 预防医学 预防医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 腹腔大动脉瘤 (AAA) 是死亡的一个重要原因.
- 目前的查指南旨在识别高风险人群中的AAA.
- 根据不同的指南对AAA选的程度及其对破裂率的影响需要进一步调查.
研究的目的:
- 根据美国预防服务特别工作组 (USPSTF) 和血管外科协会 (SVS) 的指导方针,确定腹腔大动脉动脉瘤 (AAA) 的低查率.
- 评估AAA查对破裂率的影响.
- 调查是否已经存在的医疗并发症会影响患者接受AAA查的可能性.
主要方法:
- 利用TrinetX Analytics国家数据库来识别符合AAA查条件的患者.
- 根据USPSTF和SVS指南定义了三个患者队列:符合USPSTF资格 (男性吸烟者65-75岁),符合SVS资格 (任何吸烟者≥65岁) 和仅符合SVS资格 (女性≥65岁,男性≥75岁).
- 在每个队列中,比较了查与未查的个体,使用适应年龄,种族/种族和医疗利用的倾向评分,通过ICD-10代码识别AAA和并发症.
主要成果:
- 观察到的查率较低:符合USPSTF条件的患者的3.98%,符合SVS条件的患者的2.12%,仅符合SVS条件的患者的0.83%.
- 在所有指南定义的组中,查与明显较低的AAA破裂率有关 (ORs从0.416到0.717,P<0.05).
- 被查的队列表现出更高的伴随性疾病比率,如高脂血症和高血压,而较低的条件比率,如和痴呆症被注意到后倾向匹配.
结论:
- 很大一部分符合AAA查条件的个人没有接受查,特别是在SVS指南下.
- AAA查,无论使用什么指南,都有效降低动脉瘤破裂的风险.
- 某些医学并发症的存在似乎影响了获得AAA查的决策过程.
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