联合预测模型对急性A型主动脉夹层破裂的诊断价值

The Diagnostic Value of Combined Prediction Model for Acute Type A Aortic Dissection Rupture

目的 创建了一个联合预测模型并探讨其预测急性A型主动脉夹层(acute type A aortic dissection,ATAAD)破裂风险的价值。方法 回顾性分析2018年9月至2020年12月在某三甲医院就诊的ATAAD患者的相关资料以及入院后首次肌钙蛋白I(troponin-I,cTn-I)值,根据患者入院后是否发生主动脉破裂死亡将患者分为死亡组(n=44)和存活组(n=109)。比较2组患者的一般资料及cTn-I值是否存在差异,并采用二元逻辑回归分析探索ATAAD患者破裂死亡的相关危险因素。结果 2组患者在晕厥、WBC> 15×10^(9)/L、心包积血、主动脉周围血肿方面,差异有统计学意义(P <0.05),而在其余方面,差异无统计学意义(P> 0.05)。2组患者的cTnI值差异有统计学意义(P <0.05)。晕厥、WBC> 15×10^(9)/L、心包积血、主动脉周围血肿及cTn-I被纳入二元逻辑回归分析。多因素分析表明心包积血、主动脉周围血肿、cTn-I水平的差异有统计学意义,联合上述因素创建的联合模型预测ATAAD破裂死亡的AUC为0.859(P <0.05)。结论 联合预测模型对预测ATAAD破裂具有一定预测价值。

Objective To create a combined model and explore its value in predicting the rupture risk of acute type A aortic dissection(ATAAD).Methods The relevant data and the first cTn-I value of the ATAAD patients admitted and treated in a tertiary hospital from September 2018 to December 2020 were collected and analyzed retrospectively.The patients were divided into the dead group according to whether they died after admission(n=44)and the survival group(n=109).The general data and cTn-I value of the two groups were compared,and a binary logistic regression analysis was used to explore the risk factors related to the in-hospital rupture of ATAAD.Results There were significant differences in syncope,WBC>15×10^(9)/L,pericardium,and periaortic hematoma between the two groups(P<0.05),but no significant differences in other aspects(P>0.05).There was significant difference in cTn-I value between the two groups(P<0.05).Syncope,WBC>15×10^(9)/L,pericardium,periaortic hematoma and cTn-I were included in binary logistic regression analysis.The results showed that there were significant differences in the multivariate analysis of pericardium,periaortic hematoma,and cTn-I value.The combined model created by combining the above factors predicted the AUC of ATAAD rupture was 0.859(P<0.05).Conclusion The joint prediction model has the prediction performance.