急性Stanford A型主动脉夹层急诊手术患者预后相关生物标记物的分析研究

Correlation between biomarkers and in-hospital mortality in patients with acute Stanford type A aortic dissection

目的探讨生物标记物与急性Stanford A型主动脉夹层(ATAAD)急诊手术患者院内死亡的相关性。方法选择2014年12月至2015年7月首都医科大学附属北京安贞医院心外科收住的ATAAD急诊手术住院患者310例。根据住院期间患者的生存情况,将入选患者分为生存组(279例)和死亡组(31例)。比较两组患者的年龄、性别构成比、既往史[包括是否合并高血压、糖尿病、冠状动脉粥样硬化性心脏病(CHD)家族史、高脂血症、吸烟、饮酒和主动脉病史]、入院时的生物标记物[包括肌钙蛋白I、肌酸激酶同工酶(CK-MB)、D-二聚体、白细胞计数和左心室射血分数(LVEF)]表达水平以及出院时情况(死亡或者存活)等一般资料。将可能影响ATAAD住院患者院内死亡的因素纳入多元Logistic回归,分析影响ATAAD急诊手术住院患者院内死亡的危险因素。结果两组ATAAD急诊手术住院患者肌钙蛋白I[0.071(0.013,1.532)μg/L vs.0.052(0.014,1.133)μg/L]、D-二聚体[1 104(454,2 576)μg/L vs.1 827(752,3 475)μg/L]和白细胞计数水平[9(7,12)×10~9/L vs.12(8,17)×10~9/L]比较,差异均有统计学意义(U=3 202.000、3 316.000、3 118.000,P=0.036、0.041、0.011),其他资料比较,差异均无统计学意义(P均>0.05)。将肌钙蛋白I、D-二聚体和白细胞计数纳入多元Logistic回归分析,结果显示,白细胞计数[OR=1.133,95%CI(1.041,1.233),P=0.004]是ATAAD急诊手术住院患者院内死亡的独立危险因素。结论白细胞计数是ATAAD急诊手术住院患者院内死亡的独立危险因素。

Objective To investigate the relationship between biomarkers and in-hospital mortality in patients with acute Stanford type A aortic dissection（ATAAD）. Methods A total of 310 inpatients with ATAAD emergency surgery were selected from the Department of Cardiac Surgery in Beijing Anzhen Hospital, Capital Medical University from December 2014 to July2015. They were divided into the survival group（279 cases） and death group（31 cases） according to their survival condition during hospitalization. The general information of the age, gender,past history（including hypertension, diabetes, family history of coronary atherosclerotic heart disease,hyperlipidemia, smoking, alcohol consumption and aortic history）, the expression of biomarkers on admission [including cardiac troponin I, creatine kinase isoenzyme（CK-MB）, D-dimer, leukocyte count and left ventricle eject fraction（LVEF）] and the condition at discharge（death or survival）of these two groups were compared. The factors that may affect in-hospital mortality of ATAAD inpatients were included in the multivariate Logistic regression to analyze the risk factors affecting their in-hospital mortality. Results There were significant differences of the cardiac troponin I[0.071（0.013, 1.532） μg/L vs. 0.052（0.014, 1.133） μg/L], D-dimer[1 104（454, 2 576） μg/L vs.1 827（752, 3 475） μg/L], and leukocyte count [9（7, 12） × 10~9/L vs. 12（8, 17） ×10~9/L] between these two groups of inpatients with ATAAD emergency operation（U = 3 202.000,3 316.000, 3 118.000; P = 0.036, 0.041, 0.011）, while there was no significant difference in the other data（all P 〉 0.05）. The multivariate Logistic regression analysis showed that the leukocyte count [OR = 1.133, 95% CI（1.041, 1.233）, P = 0.004] was an independent risk factor for inhospital mortality in patients undergoing ATAAD emergency surgery. Conclusion The leukocyte count is an independent risk factor for in-hospital mortality in patients with ATAAD emergency surgery.