IMA、LP-a与Stanford A型主动脉夹层动脉瘤术预后的关系

The relationship between IMA,lp-a and prognosis of Stanford type A aortic dissection aneurysm

目的探讨缺血修饰白蛋白(IMA)、血清脂蛋白-a(LP-a)与Stanford A型主动脉夹层动脉瘤(SAAD)患者术后预后的相关性。方法对河南省胸科医院2019年1至12月326例接受主动脉手术的SAAD患者进行分析。术后对SAAD患者随访2年,根据随访期间全因死亡概率分为存活组276例和死亡组50例,比较两组患者临床资料及血清IMA、LP-a水平差异。采用多因素Logistic回归模型分析SAAD患者术后预后不良危险因素。进行受试者操作特征(ROC)分析,评估血清IMA、LP-a对预后的预测价值。结果与存活组相比,死亡组的血清IMA、LP-a水平升高,差异有统计学意义(P<0.05)。年龄(OR=2.825,P=0.009),术前肾灌注不良(OR=4.162,P=0.012),D-二聚体(OR=6.206,P=0.002)、血清IMA水平(OR=3.112,P<0.001)、血清LP-a水平(OR=5.412,P=0.005)为SAAD患者住院死亡的独立危险因素。当血清IMA最佳截断值为76.78 kU/L时,诊断SAAD术后发生全因死亡AUC为0.754(95%CI0.612~0.831),灵敏度为61.32%,特异性84.51%;血清LP-a水平最佳截断值为118.52 mmol/L,血清LP-a诊断SAAD术后发生全因死亡的AUC为0.747(95%CI 0.679~0.813),灵敏度为62.35%,特异性82.17%。两者联合诊断SAAD术后发生全因死亡的AUC为0.892(95%CI 0.847~0.927),灵敏度为86.74%,特异性80.02%。结论血清IMA、LP-a水平升高与SAAD患者术后死亡具有明显正相关性,今后可考虑将其作为预后的独立预测标志物。

Objective To investigate the correlation between ischemia modified albumin(IMA),serum lipoprotein-a(lp-a)and the prognosis of patients with Stanford type A aortic dissecting aneurysm(Saad).Methods 326 Saad patients who underwent continuous aortic surgery from January to December2019 were analyzed.The patients with Saad were followed up for 2 years.According to the probability of allcause death during the follow-up period,they were divided into 276 cases in the survival group and 50 cases in the death group.The clinical data and serum IMA and lp-a levels of the two groups were compared.Multivariate logistic regression model was used to analyze the risk factors of poor prognosis in Saad patients.The subjects’operating characteristics(ROC)were analyzed to evaluate the prognostic value of serum IMA and lp-a.Results Compared with the survival group,the levels of serum IMA and lp-a in the death group increased(P<0.05).Age(OR=2.825,P=0.009),poor preoperative renal perfusion(OR=4.162,P=0.012),D-Dimer(OR=6.206,P=0.002),serum IMA level(OR=3.112,P<0.001),serum lp-a level(OR=5.412,P=0.005)were identified as independent risk factors for in-hospital death in Saad patients.When the optimal cutoff value of serum IMA was 76.78 Ku/L,the AUC of diagnosis of all-cause death after Saad was 0.754(95%CI 0.612-0.831),the sensitivity was 61.32%,and the specificity was 84.51%;The optimal cutoff value of serum lp-a level was 118.52 mmol/L.the AUC of serum lp-a in diagnosing all-cause death after Saad was 0.747(95%CI0.679-0.813),the sensitivity was 62.35%,and the specificity was 82.17%.The AUC of all-cause death after Saad was 0.892(95%CI 0.847-0.927),the sensitivity was 86.74%,and the specificity was 80.02%.Conclusion The increase of serum IMA and lp-a levels has a significant positive correlation with the long-term death of Saad patients,which can be considered as an independent prognostic marker in the future.