[1]高珩 邓超 李媛媛 钟亮 王雪.急性Stanford A型主动脉夹层患者术前炎症、凝血相关标志物及肌酐清除率与术后死亡的关系研究[J].心血管病学进展,2022,(12):1134.[doi:10.16806/j.cnki.issn.1004-3934.2022.12.018]
　GAO Heng,DENG Chao,LI Yuanyuan,et al.Relationship of Preoperative Inflammation and Clotting Related Biomarkers ,Creatinine Clearance Rate with Postoperative Death in Patients with Acute Stanford Type A Aortic Dissection[J].Advances in Cardiovascular Diseases,2022,(12):1134.[doi:10.16806/j.cnki.issn.1004-3934.2022.12.018]
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急性Stanford A型主动脉夹层患者术前炎症、凝血相关标志物及肌酐清除率与术后死亡的关系研究()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2022年12期
页码:
1134
栏目:
论著
出版日期:
2022-12-25

文章信息/Info

Title:
Relationship of Preoperative Inflammation and Clotting Related Biomarkers ,Creatinine Clearance Rate with Postoperative Death in Patients with Acute Stanford Type A Aortic Dissection
作者:
高珩1 邓超2 李媛媛2 钟亮2 王雪2
(1.陕西省人民医院急诊内科,陕西 西安 710068;2.西安交通大学第一附属医院心血管外科,陕西 西安 710061)
Author(s):
GAO Heng1; DENG Chao2; LI Yuanyuan2 ; ZHONG Liang2 ; WANG Xue2
(1.Department of Emergency?Internal Medicine,Shaanxi Provincial Peoples Hospital,Xian 710068 ,Shaanxi,China;2.Department of Cardiovascular Surgery,First Affiliated Hospital of Xian Jiaotong University, Xi an 710061,Shaanxi,China)
关键词:
急性Stanford A型主动脉夹层; 凝血标志物; C反应蛋白; 肌酐清除率
Keywords:
Acute type A aortic dissection; ?Coagulation markers; C-reactive protein; ?Creatinine clearance
DOI:
10.16806/j.cnki.issn.1004-3934.2022.12.018
摘要:
目的 分析急性Stanford A型主动脉夹层（aTAAD）患者术前炎症和凝血相关标志物及肌酐清除率（CCr）与长期预后的关系，评估其联合预测价值，旨在确定一种快速和最佳的评估指标来预测aTAAD术后死亡率。方法 对2019年6月—2021年6月在西安交通大学第一附属医院心血管外科住院且行外科手术治疗的aTAAD患者进行筛选，共纳入患者325例，随访半年，失访6例，最终纳入符合研究标准的患者319例，其中男性221例，女性98例，平均年龄54（46~61）岁，按照术后半年内是否死亡分为死亡组和存活组，死亡组76例，存活组243例。结果 死亡组患者术前白细胞、中性粒细胞（NEU）、C反应性蛋白、纤维蛋白原降解产物（FDP）和D-二聚体（DD）水平明显高于存活组，死亡组患者纤维蛋白原、CCr、血小板（PLT）和住院时间明显低于存活组。通过多因素非条件logistic回归分析发现NEU、PLT、CCr、DD及FDP是影响aTAAD患者术后预后的危险因素。CCr+PLT+NEU+DD+FDP联合预测aTAAD预后的价值最高，ROC分析曲线下面积为0.967[95% CI 0.949～0.986)]，其敏感度为93.4%，特异度为90.5%，均高于独立预测指标。CCr+PLT+NEU+DD+FDP最佳临界值为4.36，根据界值分为CCr+PLT+NEU+DD+FDP＞4.36和CCr+PLT+NEU+DD+FDP＜4.36两组，绘制生存曲线发现CCr+PLT+NEU+DD+FDP＜4.36组生存率小于CCr+PLT+NEU+DD+FDP＞4.36组，且Log Rank检验P＜0.01。结论 aTAAD患者的术前NEU、PLT、FDP、DD和CCr均可作为此类患者长期预后的独立危险因素，其联合使用可提高临床预后评估的准确性。
Abstract:
Objective To analyze the relationship of preoperative inflammation and blood clotting related markers ,creatinine clearance rate (CCr) with long-term prognosis of acute Stanford type A aortic dissection (aTAAD) and assess the joint predictive value for determing a rapid and optimal evaluation index to predict postoperative mortality of aTAAD . Methods A total of 319 aTAAD patients,including 221 males and 98 females with an average age of 54 (46 ~61) years,hospitalized in Department of Cardiovascular Surgery of First Affiliated Hospital of Xi’an Jiaotong University from June 2019 to June 2021 were screened,followed up for half a year and divided into death group ( n=76) and survival group (n=243) according to whether they died within half a year after operation. Results The levels of white blood cell,neutrophil (NEU) ,C-reactive protein,fibrinogen degradation products (FDP) and D-dimer (DD) were significantly higher ,while fibrinogen,CCr,blood platelet (PLT) and length of hospital stays were lower in death group than survival group. Multivariate non-conditional logistic regression analysis showed that NEU,PLT,CCr,DD and FDP were risk factors for postoperative prognosis of aTAAD. Combined application of CCr,PLT,NEU,DD,FDP exhibited the highest predictive value for aTAAD prognosis ,with the area under ROC curve of 0.967 (95%CI 0.949~0.986,the sensitivity of 93.4% and specificity of 90.5%) and the optimal critical value of 4.36. Based on threshold value we then separated them into ＞4.36 and ＜4.36 group. Survival curve showed the survival rate of ＜4.36 group was lower than that of ＞4.36 group,with P＜0.01?of Log Rank test.Conclusion Preoperative levels of NEU,PLT,FDP,DD and CCr could be thought as independent risk factors for long-term prognosis of aTAAD patients ,of which the combin ed application may improve the accuracy of clinical prognosis assessment.

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更新日期/Last Update: 2023-02-03