二尖瓣置换术后瓣膜不匹配（PPM）:一项倾向性评分研究_【随心英语】

【文献快递第27期】本文献出自《AnnThoracSurg》，该文献j讲述的是二尖瓣置换术后瓣膜不匹配对临床效果的影响...

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如果喜欢该文章，或者还想通过更多文章学习专业英语，可以通过右上角按钮有查看公众号按钮，欢迎关注随心英语。在上个月的ATS上，有一篇来自荷兰的关于主动脉瓣膜置换术后瓣膜不匹配（PPM）对于长期生存率的研究，最后得出的结论是PPM不是主动脉瓣置换术后远期生存时间减少的独立预测因素。我们随心英语也对这篇文献进行了翻译和解读。

有趣的是，这个月的ATS上又发表了一篇来自于韩国的报道，讲述的是二尖瓣置换术后PPM对临床效果的影响，我们今天来关注一下，二尖瓣和主动脉瓣的PPM会有何不同。

Patient-Prosthesis Mismatch After Mitral Valve Replacement:A Propensity Score Analysis

Ho Young Hwang, MD, PhD, Yong Han Kim, MD, Kyung-Hwan Kim, MD, PhD,Ki-Bong Kim, MD, PhD, and Hyuk Ahn, MD, PhD

Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea

(Ann Thorac Surg 2016;101:1796–803)

二尖瓣置换术后瓣膜不匹配（PPM）:一项倾向性评分研究

Background.

We evaluated the impact of patient prosthesis mismatch (PPM) after mitral valve replacement on the clinical outcomes using propensity score models.

背景：

在这篇文章中，作者使用倾向性评分模型分析了二尖瓣置换术后瓣膜不匹配对于临床相关的影响。

Methods.

In all, 760 patients (aged 51 ±12 years; male: female, 252:508) in whom mitral valve replacement was performed using three types of mechanical valves and two types of bioprosthetic valves were enrolled. In vivo data of effective orifice area was drawn from literatures and mitral PPM was defined as an effective orifice area index 1.2cm2/m2 or less. The propensity score model was used in two ways: the inverse probability of treatment weighting-adjusted multivariable analyses, and 1:1 propensity score matching. The duration of the follow-up was 127 months (range,1 to 276).

方法：

共有760名病人入选这项研究，平均年龄51± 12岁，男女比例为252:508，这些病人中分别置换了三种机械瓣和两种生物瓣。其中体内的有效瓣口面积是通过阅读文献确定的，而二尖瓣的PPM的定义为有效瓣口面积体表指数小于或者等于1.2cm2/m2。以两种方式应用倾向性评分模型：治疗加权调整的多变量分析的逆概率，和1：1的倾向评分匹配。平均随访时间为127个月（范围，1至276）。

Results.

Mitral PPM was identified in19.3%. The patients with PPM (PPM group, n = 147) were older and had more comorbidities than the patients without PPM (non-PPM group, n=613). The 10-year and 20-year overall survival and freedom from cardiac death were 83.5% and71.3%, respectively, for the PPM group; and 90.2% and 83.1%, respectively, for the non-PPM group. The inverse probability of treatment weighting-adjusted multivariable analyses demonstrated that mitral PPM is a significant risk factor for overall survival (hazard ratio 1.681, 95% confidence interval: 1.139 to 2.482) and freedom from cardiac death (hazard ratio 1.673, 95% confidence interval: 1.012 to2.765). The propensity score matching extracted 68 pairs. Both overall survival and freedom from cardiac death were also higher in the propensity score-matched non-PPM group than in the PPM group (p < 0.039 and p < 0.017,respectively).

结果：

发现有19.3%的病人术后出现PPM。PPM组病人（n=147）的年龄更大，与非PPM组（n=613）相比，PPM组病人的合并症更多。所有患者（PPM组+非PPM组）10年和20年的总生存率分别为83.5% 和71.3%，免于心源性死亡的概率分别为90.2%和83.1% 。

（这是按照文中的内容翻译的，而如果按照摘要翻译则为：PPM组10年和20年的总生存率分别为83.5% 和71.3%，非PPM组的免于心源性死亡的概率分别为90.2%和83.1%。这与文中的内容不符，从Figure1和2看，应为The 10-year and 20-year overall survival were 83.5% and71.3%, respectively, and freedom from cardiac death were 90.2% and 83.1%,respectively. For the PPM group, the 10-year and 20-year survival were 74.9% and 61.4%, respectively, and freedom from cardiac death were 80.8% and 57.5%,respectively; For the non-PPM group, the 10-year and 20-year survival were 85.6%and 73.4%, respectively, and freedom from cardiac death were 92.2% and 84.7%,respectively.译者已发信，作者也已经向杂志社申请修改）。

治疗加权调整的多变量分析的逆概率证明二尖瓣术后PPM是影响总生存率（风险比率为1.681，95％置信区间：1.139到2.482）和免于心源性死亡率（风险比率为1.673，95％置信区间：1.012到2.765）的显著危险因素。倾向性评分匹配了68对患者，结果发现非PPM组的总生存率和免于心源性死亡的概率都显著高于倾向性评分匹配的PPM组患者。

Conclusions.

Mitral PPM significantly affects long-term outcomes after mitral valve replacement in terms of long-term survival and freedom from cardiac death.

结论：

二尖瓣置换术后的PPM影响二尖瓣置换术后的远期疗效，包括远期生存率和免于心源性死亡的概率。

Fig 1.

Fig 2.

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