炎性反应在急性A型主动脉夹层并发肺损伤中的作用

Role of inflammation in stanford type A acute aortic dissection complicated by lung injury

目的通过对患者血清C反应蛋白(CRP)和白介素6(IL-6)水平进行检测,探讨和明确炎性反应在急性A型主动脉夹层并发肺损伤中的作用。方法搜集27例急性A型主动脉夹层患者的相关临床资料,此类患者均保守治疗超过4 d,期间死亡或手术治疗的患者予以排除。所有患者在入院后每间隔4 h行动脉血气分析及血清CRP水平、IL-6水平检测。将肺损伤定义为患者静态吸氧状态下,氧合指数(Pa O2/Fi O2)≤200。根据此标准,将患者分为A组(n=9)和B组(n=18),即肺损伤阳性组(Pa O2/Fi O2≤200)和肺损伤阴性组(Pa O2/Fi O2>200)。运用t检验、方差分析、χ2检验、Spearman相关分析等方法评估患者血清CRP水平和IL-6水平与急性A型主动脉夹层并发肺损伤的关系。结果 19例(33.3%)患者在术前出现肺损伤。2A、B两组患者血清CRP入院水平[(15.7±4.9)mg/L vs.(13.6±5.2)mg/L,P=0.564]和IL-6入院水平(25.5±11.2 vs.17.8±7.9,P=0.167)的差异无统计学意义,但是2组患者CRP峰值水平(114.8±37.8 vs.53.2±14.6,P=0.002)和IL-6峰值水平(118.6±47.3 vs.70.4±18.9,P=0.031)存在显著差异。3随着时间的推移,患者血清CRP、IL-6水平与氧合指数密切相关(R值分别为-0.878、-0.655)。结论急性A型主动脉夹层激活全身性炎性反应在肺组织损伤中起到至关重要的作用,伴随着发病时间的推移,患者血清CRP、IL-6水平与低氧血症密切相关。

Objective To explore the role of inflammation in Stanford type A acute aortic dissection complicated by lung injury by testing the levels of serum C-reactive protein（ CRP） and Interleukin 6（ IL-6）. Methods The clinical data of 27 cases of Stanford type A acute aortic dissection were reviewed. All patients received at least 4 days of conservative treatment. The patients undergoing surgery treatment and dead cases were excluded. The arterial blood gas analysis,serum CRP and IL-6 level determination were performed quaque 4 hora. Lung injury was defined as the lowest Pa O2/ Fi O2≤200,by this criterion,the patients were divided into group A（ Lung injury） and group B（ non- Lung injury）. The correlation between Stanford type A acute aortic dissection complicated by lung injury and the levels of serum CRP and IL-6 were analyzed by using t-test,ANOVA,Chi-squared test and spearman correlation analysis. Results 1 Nine patients（ 33. 3%）were with lung injury before the operations. 2 The CRP levels at admission were（ 15. 7 ± 4. 9） mg / L in group A and（ 13. 6 ± 5. 2） mg/L in group B,P = 0. 564; IL-6 levels at admission were 25. 5 ± 11. 2 in the group A and 17. 8 ± 7. 9 in the group B,P = 0. 167,the difference was not statistical significant. The peak levels of CRP（ 114. 8 ± 37. 8 vs. 53. 2 ±14. 6,P = 0. 002） and IL-6（ 118. 6 ± 47. 3 vs. 70. 4 ± 18. 9,P = 0. 031） were obviously significant between the two groups. 3With the past of time,serum CRP level and serum IL-6 level were correlated with oxygenation index（ R =0. 878,R =- 0. 655,respectively）. Conclusion The inflammatory after aortic injury may play an important role in the development of Lung injury. With the past of time,serum CRP level and IL-6 level were correlated with oxygenation impairment.