[1]陈晋波 张云静 李素彦 李旭蕊 梁小华.α-HBDH与急性主动脉夹层患者院内病死率的相关性[J].心血管病学进展,2022,(11):1050.[doi:10.16806/j.cnki.issn.1004-3934.2022.09.019]
　CHEN Jinbo,ZHANG Yunjing,LI Suyan,et al.Association Between -HBDH and In-Hospital Case Fatality Rate?n Patients with Type A Aortic Dissection[J].Advances in Cardiovascular Diseases,2022,(11):1050.[doi:10.16806/j.cnki.issn.1004-3934.2022.09.019]
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α-HBDH与急性主动脉夹层患者院内病死率的相关性()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2022年11期
页码:
1050
栏目:
论著
出版日期:
2022-11-25

文章信息/Info

Title:
Association Between -HBDH and In-Hospital Case Fatality Rate?n Patients with Type A Aortic Dissection
作者:
陈晋波1 张云静2 李素彦3 李旭蕊3 梁小华1
(1.石家庄市第二医院,河北 石家庄 050051;2.华北理工大学公共卫生学院,河北 唐山 063210;3.河北省人民医院,河北 石家庄 050057)
Author(s):
CHEN Jinbo1; ZHANG Yunjing2; LI Suyan3; LI Xurui3; LIANG Xiaohua1?/html>
(1.Shijiazhuang Second Hospital,Shijiazhuang 050051,Hebei,China; 2. School of Public Health,North China University of Science and Technology ,Tangshan 063210,Hebei,China; 3. Hebei Provincial People’s Hospital,Shijiazhuang 050057,Hebei,China)
关键词:
α-羟基丁酸脱氢酶; 急性主动脉夹层; 院内死亡率
Keywords:
α-Hydroxybutyrate dehydrogenase; Acute aortic dissection; In-hospital mortality
DOI:
10.16806/j.cnki.issn.1004-3934.2022.09.019
摘要:
目的 探讨 α-羟基丁酸脱氢酶（α-HBDH）与急性主动脉夹层（AAD）患者术后院内死亡率之间的关系。方法 采用回顾性观察研究，收集2015年1月—2021年6月于河北省石家庄市第二医院住院的AAD患者369例，依据AAD患者入院α-HBDH水平分为正常组（n＝130）与升高组（n＝239）并进行院内死亡率的比较。采用受试者操作特征曲线评价α-HBDH对AAD患者院内30 d 内死亡率的预测作用，计算α-HBDH连续变量的最佳截断值。依据最佳截断值将AAD患者的入院α-HBDH水平分为：α-HBDH≤272.2 U/L组（n＝263）和α-HBDH水平＞272.2 U/L组（n＝106），通过三维柱形图观察不同组别之间院内未死亡与死亡人数所占百分比的高低。Kaplan-Meier方法分析依据最佳截断值分组后两组患者术后30 d 的累计生存率并用log-rank检验。单因素和多因素Cox回归校正混杂因素分析AAD患者住院死亡的独立危险因素。结果 观察到曲线下面积为0.731（95% CI 0.640～0.823 ，P＜0.001），截断值＝272.3单位敏感度为62.2%，特异度为75.0%，对AAD患者院内的30 d 内死亡率有一定的预测价值。依据最佳截断值分组，三维柱形图显示α-HBDH≤272.2 U/L组总体死亡率为5.3%，α-HBDH＞272.2 U/L组总体死亡率为21.7%，α-HBDH＞272.2 U/L组AAD患者术后30 d 内死亡率明显升高，是α-HBDH≤272.2 U/L组的4倍左右（P＜0.001）。Kaplan-Meier分析结果显示，α-HBDH入院水平升高，AAD患者的术后30 d 内生存率降低（log-rank,P＜0.01）。单因素和多因素Cox回归分析表明，Stanford A型（HR＝6.254，95% CI 1.854～21.092，P＝0.003）和α-HBDH（HR＝4.399，95% CI 2.191～8.833，P＜0.001）是AAD患者术后院内死亡的危险因素。结论 AAD患者入院α-HBDH水平可能与术后住院死亡相关，α-HBDH可能成为预测AAD患者短期预后的生物标志物。
Abstract:
Objective To investigate the relationship between α-hydroxybutyrate dehydrogenase(α-HBDH) and postoperative mortality in hospital of acute aortic dissection( AAD) patients. Methods In this r etrospective observational study,a total of 369 AAD patients admitted to the Shijiazhuang Second Hospital from January 2015 to June 2021 were enrolled and divided into normal group( n＝130) and elevated group(n＝239) according to the admission α-HBDH level,and the in-hospital mortality was compared. ROC curve was used to evaluate the predictive effect of α-HBDH on the mortality of AAD patients within 30 days of hospitalization ,and the optimal cut-off value of α-HBDH continuous variable was calculated. According to the optimal cut-off value,AAD patients were divided into low level α-HBDH ≤272.2 U/L group (n＝263) and high level α-HBDH＞272.2 U/L group (n＝106). The percentages of non-hospital deaths and deaths among different groups were observed by 3D columnchart. Kaplan-meier method was used to analyze the 30-day cumulative survival rate of the two groups after grouping according to the optimal cut-off value and log-rank test was performed. Univariate and multivariate Cox regression were used to analyze the independent risk factors for in-hospital death in AAD patients. Results The area under the curve was 0.731 (95% CI 0.640 ～0.823, P<0.001), the cut-off value = 272.3 units, the sensitivity was 62.2%, and the specificity was 75.0%. It has a certain predictive value for the in-hospital mortality of AAD patients within 30 days. According to the optimal cut-off value,the overall mortality was 5.3% in the low expression group(α-HBDH≤272.2 U/L) and 21.7% in the high expression group(α-HBDH＞272.2 U/L). The mortality of AAD patients in the high expression group was significantly increased within 30 days after surgery ,which was four times as much as the low expression group(P＜0.001). Kaplan-Meier analysis showed that α-HBDH admission levels elevation related to intraoperative survival within 30 days of AAD decrea se(log-rank,P<0.01). Univariate and multivariate Cox regression analysis showed that Stanford type A( HR＝6.254,95% CI 1.854 ～21.092,P＝0.003) and α-HBDH(HR＝4.399,95% CI 2.191～8.833,P＜0.001) were risk factor for postoperative nosocomial mortality in AAD patients. Conclusion The admission α-HBDH levels of patients with AAD may be associated with postoperative hospitalization death, andα-HBDH may be a biomarker predicting short-term prognosis for patients with AAD.

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更新日期/Last Update: 2023-01-31