血糖和血钙预测主动脉根部扩张性疾病的倾向性评分匹配研究

Predictive value of glycemia and serum calcium in aortic root dilation disease:A propensity score matching study

目的分析血糖和血钙对主动脉根部扩张性疾病发生、发展的影响。方法回顾性分析2011年1月—2021年10月于新疆医科大学第一附属医院心外科行手术治疗主动脉根部扩大患者的临床资料。根据是否伴有急性主动脉夹层(Stanford A型)将患者分为两组,并应用倾向性评分法对其进行匹配。采用单因素和多因素logistic回归模型分析患者入院24 h内的血糖和血钙对主动脉根部扩张的影响,并绘制其受试者工作特征(receiver operating characteristic,ROC)曲线。结果成功匹配184对患者,其中男297例[平均年龄(48.76±9.62)岁]、女71例[平均年龄(49.97±10.97)岁]。民族、高血压史、主动脉根部直径、血钙以及血糖在两组患者中差异具有统计学意义(P<0.05)。多因素logistic回归分析结果表明,年龄<40岁(OR=4.106,P=0.010)、汉族(OR=2.863,P<0.001)、主动脉根部直径<45 mm(OR=5.063,P<0.001)、高血压(OR=2.736,P=0.001)、高血糖(OR=4.426,P<0.001)以及低血钙(OR=5.375,P<0.001)是主动脉根部扩张性疾病伴夹层的独立危险因素。ROC曲线分析提示,血糖曲线下面积(area under the curve,AUC)为0.742、血钙AUC为0.737,均对主动脉根部扩张伴夹层有一定的预测价值。结论高血糖和低血钙是主动脉根部扩张性疾病发生、发展的危险因素,某种程度上可用作筛选主动脉根部扩张性疾病高危患者的指标。

Objective To explore the effects of glycemia and serum calcium on occurrence and development of aortic root dilation disease.Methods The clinical data of patients with aortic root dilation who underwent surgical treatment in the Department of Cardiac Surgery of the First Affiliated Hospital of Xinjiang Medical University from January 2011 to October 2021 were retrospectively collected.They were divided into two groups according to whether they were accompanied by acute aortic dissection(Stanford type A),and were matched with the propensity scoring method.Logistic univariate and multivariate regression analyses were used to analyze the glycemia and the serum calcium of the patients in 24 hours at admission,and their receiver operating characteristic(ROC)curves were plotted.Results Finally 184 pairs of patients were matched,including 297 males with an average age of 48.76±9.62 years and 71 females with an average age of 49.97±10.97 years.There were statistical differences in ethnicity,history of hypertension,aortic root diameter,serum calcium and glycemia between the two groups(P<0.05).Logistic multivariate regression analyses results showed that age<40 years(OR=4.106,P=0.010),Han nationality(OR=2.863,P<0.001),aortic root diameter<45 mm(OR=5.063,P<0.001),hypertension(OR=2.736,P=0.001),hyperglycemia(OR=4.426,P<0.001)and hypocalcemia(OR=5.375,P<0.001)were independent risk factors for aortic root dilation disease with dissection.ROC curve analysis suggested that the area under the curve(AUC)of glycemia was 0.742 and the AUC of serum calcium was 0.737,all of which had some predictive value.Conclusion Hyperglycemia and hypocalcemia are risk factors for the development of aortic root dilation disease,and to some extent,they can be used as indicators for screening high-risk patients with aortic root dilation disease.