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NEJM：血管性血友病因子可预测TAVR术后反流及死亡率

2016-07-28 MedSci MedSci原创

血友病因子CT-ADP主动脉反流
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经导管主动脉瓣置换术(TAVR)后有10%-20%的患者会出现主动脉瓣反流。我们假设高分子量(HMW)多聚体的血管性血友病因子缺陷或止血功能即使检验可以用来监测TAVR术后主动脉瓣返流。 共有183例TAVR术后患者入组。首次置换术后经食管超声心动图确定出现主动脉反流后，进行额外的球囊扩张纠正反流。评估基线HMW多聚体和腺苷二磷酸(CT-ADP)——一种止血功能的即时检验及使用5分钟后的数值

经导管主动脉瓣置换术(TAVR)后有10%-20%的患者会出现主动脉瓣反流。我们假设高分子量(HMW)多聚体的血管性血友病因子缺陷或止血功能即使检验可以用来监测TAVR术后主动脉瓣返流。

共有183例TAVR术后患者入组。首次置换术后经食管超声心动图确定出现主动脉反流后，进行额外的球囊扩张纠正反流。评估基线HMW多聚体和腺苷二磷酸(CT-ADP)——一种止血功能的即时检验及使用5分钟后的数值。评估1年后的死亡率。第二组中 (201例患者) 使用CT-ADP以证实患者存在主动脉瓣反流。

结果：在初次置换术后， HMW多聚体在无主动脉瓣反流的患者(137 人)中是正常的。在46例主动脉反流患者中，HMW多聚体在20例经球囊扩张手术成功无反流的患者中是正常的，而在另外26例持续反流的患者中是异常的。 CT-ADP也出现了类似的变化。CT-ADP值在超过180秒时有特异性和灵敏性，对主动脉反流的阴性预测值分别为 92.3%, 92.4%,和98.6%,在验证队列中也有相似的结果。多变量分析显示HMW多聚体和CT-ADP值在TAVR术后与1年的死亡率相关。

结论：HMW多聚体缺陷和高的CT-ADP值都可预测TAVR术后主动脉反流，且与患者术后1年的高死亡率相关。

原始出处：

Eric Van Belle, M.D., Ph.D., Antoine Rauch, et al,Von Willebrand Factor Multimers during Transcatheter Aortic-Valve Replacement,N Engl J Med 2016; 375:335-344July 28, 2016



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    2017-06-20 zz12341243

    #血友病因子#

    0

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    2017-04-15 仁心济世

    #血管性#

    0

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    2016-09-01 李东泽

    很好，不错，以后会多学习

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1681791, encodeId=66a81681e91cf, content=<a href='/topic/show?id=425c889838a' target=_blank style='color:#2F92EE;'>#血友病因子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88983, encryptionId=425c889838a, topicName=血友病因子)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f6d627864101, createdName=zz12341243, createdTime=Tue Jun 20 12:38:00 CST 2017, time=2017-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1812326, encodeId=16601812326fd, content=<a href='/topic/show?id=9ff9896405e' target=_blank style='color:#2F92EE;'>#血管性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89640, encryptionId=9ff9896405e, topicName=血管性)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Sat Apr 15 19:38:00 CST 2017, time=2017-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=109253, encodeId=66fa109253be, content=很好，不错，以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Thu Sep 01 23:54:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=108839, encodeId=1de710883986, content=很好，不错，以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Thu Sep 01 12:56:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=105772, encodeId=85e8105e720b, content=这篇资讯带给我们新知识，启发新思维，不论是科研还是临床工作都有很大的帮助。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Sat Aug 27 21:43:00 CST 2016, time=2016-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=98747, encodeId=816f98e4773, content=加大研究投入, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fe991935216, createdName=1e0db677m16(暂无匿称), createdTime=Mon Aug 15 06:40:00 CST 2016, time=2016-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086301, encodeId=f893208630198, content=<a href='/topic/show?id=134b304456' target=_blank style='color:#2F92EE;'>#AVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3044, encryptionId=134b304456, topicName=AVR)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Sat Aug 13 19:38:00 CST 2016, time=2016-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1571569, encodeId=7ccc15e1569bd, content=<a href='/topic/show?id=41e33e76137' target=_blank style='color:#2F92EE;'>#反流#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37761, encryptionId=41e33e76137, topicName=反流)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=220d15750403, createdName=feifers, createdTime=Sat Jul 30 03:38:00 CST 2016, time=2016-07-30, status=1, ipAttribution=)]
    2016-09-01 李东泽

    很好，不错，以后会多学习

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1681791, encodeId=66a81681e91cf, content=<a href='/topic/show?id=425c889838a' target=_blank style='color:#2F92EE;'>#血友病因子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88983, encryptionId=425c889838a, topicName=血友病因子)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f6d627864101, createdName=zz12341243, createdTime=Tue Jun 20 12:38:00 CST 2017, time=2017-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1812326, encodeId=16601812326fd, content=<a href='/topic/show?id=9ff9896405e' target=_blank style='color:#2F92EE;'>#血管性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89640, encryptionId=9ff9896405e, topicName=血管性)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Sat Apr 15 19:38:00 CST 2017, time=2017-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=109253, encodeId=66fa109253be, content=很好，不错，以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Thu Sep 01 23:54:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=108839, encodeId=1de710883986, content=很好，不错，以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Thu Sep 01 12:56:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=105772, encodeId=85e8105e720b, content=这篇资讯带给我们新知识，启发新思维，不论是科研还是临床工作都有很大的帮助。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Sat Aug 27 21:43:00 CST 2016, time=2016-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=98747, encodeId=816f98e4773, content=加大研究投入, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fe991935216, createdName=1e0db677m16(暂无匿称), createdTime=Mon Aug 15 06:40:00 CST 2016, time=2016-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086301, encodeId=f893208630198, content=<a href='/topic/show?id=134b304456' target=_blank style='color:#2F92EE;'>#AVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3044, encryptionId=134b304456, topicName=AVR)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Sat Aug 13 19:38:00 CST 2016, time=2016-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1571569, encodeId=7ccc15e1569bd, content=<a href='/topic/show?id=41e33e76137' target=_blank style='color:#2F92EE;'>#反流#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37761, encryptionId=41e33e76137, topicName=反流)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=220d15750403, createdName=feifers, createdTime=Sat Jul 30 03:38:00 CST 2016, time=2016-07-30, status=1, ipAttribution=)]
    2016-08-27 李东泽

    这篇资讯带给我们新知识，启发新思维，不论是科研还是临床工作都有很大的帮助。。。

    0

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    2016-08-15 1e0db677m16(暂无匿称)

    加大研究投入

    0

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    2016-08-13 wangtianj2007@

    #AVR#

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1681791, encodeId=66a81681e91cf, content=<a href='/topic/show?id=425c889838a' target=_blank style='color:#2F92EE;'>#血友病因子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88983, encryptionId=425c889838a, topicName=血友病因子)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f6d627864101, createdName=zz12341243, createdTime=Tue Jun 20 12:38:00 CST 2017, time=2017-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1812326, encodeId=16601812326fd, content=<a href='/topic/show?id=9ff9896405e' target=_blank style='color:#2F92EE;'>#血管性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89640, encryptionId=9ff9896405e, topicName=血管性)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Sat Apr 15 19:38:00 CST 2017, time=2017-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=109253, encodeId=66fa109253be, content=很好，不错，以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Thu Sep 01 23:54:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=108839, encodeId=1de710883986, content=很好，不错，以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Thu Sep 01 12:56:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=105772, encodeId=85e8105e720b, content=这篇资讯带给我们新知识，启发新思维，不论是科研还是临床工作都有很大的帮助。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Sat Aug 27 21:43:00 CST 2016, time=2016-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=98747, encodeId=816f98e4773, content=加大研究投入, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fe991935216, createdName=1e0db677m16(暂无匿称), createdTime=Mon Aug 15 06:40:00 CST 2016, time=2016-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086301, encodeId=f893208630198, content=<a href='/topic/show?id=134b304456' target=_blank style='color:#2F92EE;'>#AVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3044, encryptionId=134b304456, topicName=AVR)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Sat Aug 13 19:38:00 CST 2016, time=2016-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1571569, encodeId=7ccc15e1569bd, content=<a href='/topic/show?id=41e33e76137' target=_blank style='color:#2F92EE;'>#反流#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37761, encryptionId=41e33e76137, topicName=反流)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=220d15750403, createdName=feifers, createdTime=Sat Jul 30 03:38:00 CST 2016, time=2016-07-30, status=1, ipAttribution=)]
    2016-07-30 feifers

    #反流#

    0