基于炎症反应变化程度的主动脉夹层病程分期的初步探讨

Preliminary Study of A New Staging System of Aortic Dissection Based on Systemic Inflammatory Response

目的 观察不同时间段主动脉夹层患者血液中炎症介质浓度变化规律，并在炎症反应变化基础上初步探讨主动脉夹层的病程分期。方法四川大学华西医院心脏大血管外科2011年9月至2012年2月收治主动脉夹层患者46例，其中男33例、女13例，年龄22～77（53．2±13．6）岁，分别于出现首发症状到12h（0～12h，记为T1）、12～24h（T2）、24～48h（T3，1～2d）、48～96h（T4，2～4d）、96～168h（T5，4～7d）、168～336h（T6，7～14d）、336～720h（T7，14～30d）、720～1440h（T8，30～60d）和〉1440h（T9，〉60d）9个时间段采集患者血液样本，检测肿瘤坏死因子a（tumor necrosis factor-a，TNF-a）、白细胞介素6（interleukin-6，IL．6）、C反应蛋白（C-reactiv eprotein，CRP）、内毒素（endotoxin，ET）、白细胞（white blood cell，WBC）和中性粒细胞（neutrophil，Neut）炎症介质浓度，分析总结主动脉夹层患者的炎症反应变化规律。结果14d以内（T1～T6）患者血液样本中各炎症介质水平均明显增高，14～60d（T7～T8）各炎症介质水平明显下降，〉60d（T9）各炎症介质回归正常水平。ET和TNF-α的峰值均出现在T1时间段，分别为（263．42±29．98）pg／ml和（86．75±18．83）pg／ml；IL一6的峰值出现在T2时间段，为（95．70±22．64）pg／ml；CRP的峰值出现在T5时间段，为（123.74±54.78）mg／L；WBC和Neut没有明显的峰值。结论基于炎症反应变化程度，主动脉夹层病程具备急性期（≤14d）、亚急性期（14～60d）及慢性期（〉60d）三个阶段。

Abstract： Objective To observe systemic inflammatory response （SIR） of patients in different stages after the onset of aortic dissection （AD）, and preliminarily explore a new staging system of AD based on SIR. Methods From September 2011 to February 2012, 46 AD patients were admitted to the Department of Cardiovascular Surgery, West China Hospital of Sichuan University. There were 33 male and 13 female patients with their age ranging from 22 to 77 years （53.2± 13.6 years ）. Blood samples were collected in 9 different periods after the onset of AD （0-12 hours （T 1 ）, 12-24 hours （T2）, 24-48 hours （T3, 1-2 days）, 48-96 hours （T4, 2-4 days）, 96-168 hours （T5, 4-7 days）, 168-336 hours （T6, 7-14 days）, 336-720 hours （T7, 14-30 days）, 720-1440 hours （T8, 30-60 days） and 〉 1 440 hours （T9, 〉 60 days） ） to measure blood concen- trations of tumor necrosis factor-or （TNF-ct）, interleukin-6 （ IL-6 ）, C-reactive protein （ CRP ）, endotoxin （ ET ）, white blood cell （WBC） and neutrophils （Neut）. SIR changes after the onset of AD were summarized. Results Blood concentrations of different inflammatory mediators were all significantly elevated within 14 days （ T l-T6）, significantly decreased in 14-60 days （T7-T8）, and returned to normal range 60 days （T9） after the onset of AD. Peak levels of ET and TNF-ct appeared in T1 with 263.42 ± 29.98 pg/ml and 86.75± 18.83 pg/ml respectively. Peak level of IL-6 appeared in T2 with 95.70 ± 22.64 pg/ml. Peak level of CRP appeared in T5 with 123.74±54.78 mg/L. There was no obvious peak level of WBC or Neut. Conclusion Disease progression of AD can be divided into 3 stages including acute stage （within 14 days）, subacute stage （ 14-60 days） and chronic stage （ 〉 60 days ） based on the degree of SIR.