覆膜支架介入术对急性主动脉夹层患者D-二聚体及中性粒细胞-淋巴细胞比值的影响

Effect of stent-graft intervention on D-dimer and neutrophil-lymphocyte ratio in patients with acute aortic dissection

目的:探讨覆膜支架介入术治疗急性主动脉夹层临床疗效及对患者D-dimer及中性粒细胞-淋巴细胞比值的影响。方法:选取2015年1月至2017年2月,我院收治的68例最终确诊为急性B型主动脉夹层患者为研究对象,其中18例拒绝覆膜支架介入治疗(对照组),50例患者同意覆膜支架介入(治疗组);比较两组入组后及治疗组术后第1天、术后WBC、中性粒细胞数(NE)、淋巴细胞数(LY),计算中性粒细胞与淋巴细胞比值(NLR)及D-dimer水平,并观察两组围手术期情况,随访24个月记录生存率。结果:治疗组50例患者腔内覆膜支架治疗均获得成功,成功率100%,两组住院时间、院内病死率、院内并发症发生率,差异均有统计学意义(P<0.05);接受治疗前,对照组与治疗组WBC、NE、LY、NLR及D-二聚体比较,差异无统计学意义(P>0.05);治疗组给予覆膜支架介入治疗后,术前及术后第1d及第7天血液WBC、NE、LY、NLR及D-dimer比较,差异均有统计学意义(P<0.05);随访24个月,治疗组与对照组24个月累积生存率分为96.0%、33.3%,差异有统计学意义(P<0.05);各组死亡患者NE、LY、NLR及D-dimer与各组存活患者比较,差异有统计学意义(P<0.05)。结论:覆膜支架介入术可有效提高急性主动脉夹层患者生存率,术后短期内会引起血D-dimer及中性粒细胞-淋巴细胞比值增高。

Objective: To investigate the clinical efficacy of stent-graft intervention for acute aortic dissection and its effect on D-dimer and neutrophil-lymphocyte ratio. Methods: Sixty-eight patients with acute Btype aortic dissection who were admitted to our hospital from January 2015 to February 2017 were selected as subjects.18 patients refused stent-graft intervention ( control group),and 50 patients agreed with stent-graft intervention ( treatment group);The levels of WBC,NE,LY,NLR and D dimers in the two groups after operation and in the treatment group were compared. The perioperative status of the two groups was observed. The survival rate was recorded at 24 months follow-up. Results: 50 patients in the treatment group were successfully treated with intraluminal stent graft,and the success rate was 100%.There were significant differences in hospitalization time,in-hospital mortality,and in-hospital complications between the two groups ( P<0. 05). Before treatment,there was no significant difference in WBC,NE,LY,NLR and D-dimer between the control group and the treatment group ( P>0. 05).After treatment with stent-graft intervention in the treatment group, analysis of variance analysis using repeated measures design showed that blood,WBC,NE,LY,NLR,and Ddimer were compared before and 1 day after surgery ( P<0. 05);After 24 months of follow-up,the cumulative survival rate of the treatment group and the control group at 24 months was 96. 0% and 33. 3%,and the difference was statistically significant ( P<0. 05).The differences of NE,LY,NLR and D-dimer in each group of patients with survival were statistically significant ( P<0. 05). Conclusions: The stent-graft intervention can effectively improve the survival rate of patients with acute aortic dissection,and the blood D-dimer and neutrophillymphocyte ratio will increase in the short term.