血管置换术后乳酸脱氢酶水平对急性A型主动脉夹层患者近期结局的影响

Effect of lactate dehydrogenase level on short-term outcomes after vascular replacement surgery in patients with acute type A aortic dissection

目的探讨血管置换术后乳酸脱氢酶(LDH)水平对急性A型主动脉夹层(ATAAD)患者近期结局的影响。方法选择2020年10月至2022年3月于华中科技大学同济医学院附属同济医院接受血管置换手术的272例ATAAD患者的临床资料。根据患者出院时状态分为近期良好结局组(227例)及近期不良结局组(45例)。采用平滑拟合曲线分析术后LDH水平与患者近期不良结局的关系。通过多因素logistic回归分析影响患者近期不良结局的因素。结果多因素logistic回归分析结果显示,术后较高的LDH水平是患者近期预后不良的危险因素(P<0.05),术后较高的平均动脉压(MBP)水平是抑制近期不良结局发生的保护因素(P<0.05)。平滑拟合曲线显示,术后LDH水平与患者近期不良结局呈非线性关系,随着术后LDH水平升高,近期不良结局发生率升高。受试者工作特征(ROC)曲线分析结果显示,术后LDH、MBP水平均具有预测ATAAD患者近期结局的应用价值(P<0.05),且两指标联合可进一步提高预测效能[AUC(95%CI)=0.752(0.670~0.834)],灵敏度和特异度分别达81.20%、62.30%。结论术后高LDH水平是ATAAD患者近期不良结局的危险因素,指标监测有助于患者的风险分层管理,指导临床进行个性化干预,改善患者预后。

Objective To investigate the effect of lactate dehydrogenase(LDH)level on short-term outcomes after vascular replacement surgery in patients with acute type A aortic dissection(ATAAD).Methods The clinical data of 272 patients with ATAAD who underwent vascular replacement surgery at Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from October 2020 to March 2022 were selected.The patients were divided into good short-term outcome group(227 cases)and adverse short-term outcome group(45 cases)according to their discharge status.Smooth-fitting curve was used to analyze the relationship between postoperative LDH level and adverse short-term outcomes in the patients.Multivariate logistic regression was used to analyze the factors affecting the adverse short-term outcomes of the patients.Results The results of multivariate logistic regression analysis showed that higher postoperative LDH level was a risk factor of the adverse short-term prognosis in the patients(P<0.05),and higher postoperative mean blood pressure(MBP)level was a protective factor against adverse short-term outcomes(P<0.05).The smooth-fitting curve showed that postoperative LDH level had a nonlinear relationship with the patients′adverse short-term outcomes,and the incidence of adverse short-term outcomes increased with the increase of postoperative LDH level.The results of receiver operating characteristic(ROC)curve analysis showed that both postoperative LDH and MBP levels had application value in predicting the short-term outcomes of the ATAAD patients(P<0.05),and combining with the two indicators could further improve the prediction efficiency[AUC(95%CI)=0.752(0.670~0.834)].The sensitivity and specificity were 81.20%and 62.30%,respectively.Conclusion High postoperative LDH level is a risk factor of adverse short-term outcomes in patients with ATAAD.Monitoring the indicators is helpful for stratifying the risk management of the patients,guiding clinical personalized intervention,and improving the patients′prognosis.