切换至 "中华医学电子期刊资源库"
高级检索
中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2018, Vol. 11 ›› Issue (02) : 73 -77. doi: 10.3877/cma.j.issn.1674-6880.2018.02.001

所属专题： 文献；

论著

急性Stanford A型主动脉夹层急诊手术患者预后相关生物标记物的分析研究
贺晓楠1, 赵冠棋1, 张彦龙2, 孙立忠3, 聂绍平1,†()   
  1. 1. 100029　北京，首都医科大学附属北京安贞医院急诊危重症中心
    2. 026000　内蒙古锡林浩特市，锡林郭勒职业学院附属康复医院外科
    3. 100029　北京，首都医科大学附属北京安贞医院心外科
  • 收稿日期:2018-01-25 出版日期:2018-04-01
  • 通信作者: 聂绍平
  • 基金资助:
    国家高技术研究发展计划（863）重大项目(2015AA020102); 北京市医管局重点医学发展计划项目(ZYLX201710); 国家自然科学青年基金项目(81700383); 北京中医药科技发展资金项目青年研究(QN2016-2)

Correlation between biomarkers and in-hospital mortality in patients with acute Stanford type A aortic dissection

Xiaonan He1, Guanqi Zhao1, Yanlong Zhang2, Lizhong Sun3, Shaoping Nie1,†()   

  1. 1. Department of Emergency Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
    2. Department of Surgery, Rehabilitation Hospital Affiliated to Inner Mongolia Xilingol Vocational College, Xilinhot 026000, China
    3. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
  • Received:2018-01-25 Published:2018-04-01
  • Corresponding author: Shaoping Nie
  • About author:
    Corresponding Author: Nie Shaoping, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

贺晓楠, 赵冠棋, 张彦龙, 孙立忠, 聂绍平. 急性Stanford A型主动脉夹层急诊手术患者预后相关生物标记物的分析研究[J]. 中华危重症医学杂志(电子版), 2018, 11(02): 73-77.

Xiaonan He, Guanqi Zhao, Yanlong Zhang, Lizhong Sun, Shaoping Nie. Correlation between biomarkers and in-hospital mortality in patients with acute Stanford type A aortic dissection[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2018, 11(02): 73-77.

目的

探讨生物标记物与急性Stanford A型主动脉夹层（ATAAD）急诊手术患者院内死亡的相关性。

方法

选择2014年12月至2015年7月首都医科大学附属北京安贞医院心外科收住的ATAAD急诊手术住院患者310例。根据住院期间患者的生存情况，将入选患者分为生存组（279例）和死亡组（31例）。比较两组患者的年龄、性别构成比、既往史[包括是否合并高血压、糖尿病、冠状动脉粥样硬化性心脏病（CHD）家族史、高脂血症、吸烟、饮酒和主动脉病史]、入院时的生物标记物[包括肌钙蛋白I、肌酸激酶同工酶（CK-MB）、D-二聚体、白细胞计数和左心室射血分数（LVEF）]表达水平以及出院时情况（死亡或者存活）等一般资料。将可能影响ATAAD住院患者院内死亡的因素纳入多元Logistic回归，分析影响ATAAD急诊手术住院患者院内死亡的危险因素。

结果

两组ATAAD急诊手术住院患者肌钙蛋白I[0.071（0.013，1.532）μg/L vs. 0.052（0.014，1.133）μg/L]、D-二聚体[1 104（454，2 576）μg/L vs. 1 827（752，3 475）μg/L]和白细胞计数水平[9（7，12）× 109/L vs. 12（8，17）× 109/L]比较，差异均有统计学意义（U=3 202.000、3 316.000、3 118.000，P=0.036、0.041、0.011），其他资料比较，差异均无统计学意义（P均> 0.05）。将肌钙蛋白I、D-二聚体和白细胞计数纳入多元Logistic回归分析，结果显示，白细胞计数[OR=1.133，95%CI（1.041，1.233），P=0.004]是ATAAD急诊手术住院患者院内死亡的独立危险因素。

结论

白细胞计数是ATAAD急诊手术住院患者院内死亡的独立危险因素。

关键词: 生物标记物, 急性Stanford A型主动脉夹层, 院内死亡, 预后
Objective

To investigate the relationship between biomarkers and in-hospital mortality in patients with acute Stanford type A aortic dissection (ATAAD).

Methods

A total of 310 inpatients with ATAAD emergency surgery were selected from the Department of Cardiac Surgery in Beijing Anzhen Hospital, Capital Medical University from December 2014 to July 2015. They were divided into the survival group (279 cases) and death group (31 cases) according to their survival condition during hospitalization. The general information of the age, gender, past history (including hypertension, diabetes, family history of coronary atherosclerotic heart disease, hyperlipidemia, smoking, alcohol consumption and aortic history), the expression of biomarkers on admission [including cardiac troponin I, creatine kinase isoenzyme (CK-MB), D-dimer, leukocyte count and left ventricle eject fraction (LVEF)] and the condition at discharge (death or survival) of these two groups were compared. The factors that may affect in-hospital mortality of ATAAD inpatients were included in the multivariate Logistic regression to analyze the risk factors affecting their in-hospital mortality.

Results

There were significant differences of the cardiac troponin I [0.071 (0.013, 1.532) μg/L vs. 0.052 (0.014, 1.133) μg/L], D-dimer[1 104 (454, 2 576) μg/L vs. 1 827 (752, 3 475) μg/L], and leukocyte count [9 (7, 12) × 109/L vs. 12 (8, 17) ×109/L] between these two groups of inpatients with ATAAD emergency operation (U=3 202.000, 3 316.000, 3 118.000; P=0.036, 0.041, 0.011), while there was no significant difference in the other data (all P > 0.05). The multivariate Logistic regression analysis showed that the leukocyte count [OR=1.133, 95%CI (1.041, 1.233), P=0.004] was an independent risk factor for inhospital mortality in patients undergoing ATAAD emergency surgery.

Conclusion

The leukocyte count is an independent risk factor for in-hospital mortality in patients with ATAAD emergency surgery.

Key words: Biomarker, Acute Stanford type A aotic dissection, In-hospital mortality, Prognosis
表1 两组ATAAD急诊手术住院患者的一般资料比较
组别 例数 年龄（岁，±s） 性别比（例，男/女） 高血压[例（%）] 糖尿病[例（%）] CHD家族史[例（%）] 高脂血症[例（%）] 吸烟[例（%）] 饮酒[例（%）]
生存组 279 48 ± 11 196/83 190（88.8） 7（2.5） 15（5.4） 1（0.4） 125（44.8） 41（14.7）
死亡组 31 48 ± 12 25/6 24（77.4） 0 0 0 17（54.8） 7（22.6）
t/χ2值 ? 0.087 1.473 1.133 0.796 - - 1.132 1.326
P值 ? 0.931 0.225 0.287 0.799 0.198 0.900 0.287 0.374
表2 两组ATAAD急诊手术住院患者生物标记物比较[M（P25，P75）]
组别 例数 肌钙蛋白I（μg/L） CK-MB（μg/L） D-二聚体（μg/L） 白细胞计数（× 109/L） LVEF（%，±s）
生存组 279 0.071（0.013，1.532） 1.8（0.9，9.9） 1 104（454，2 576） 9（7，12） 60 ± 7
死亡组 31 0.052（0.014，1.133） 2.2（1.2，14.3） 1 827（752，3 475） 12（8，17） 59 ± 8
U/t值 ? 3 202.000 3 589.000 3 316.000 3 118.000 1.363
P值 ? 0.036 0.120 0.041 0.011 0.174
表3 ATAAD急诊手术住院患者院内死亡影响因素的多元Logistic回归分析
危险因素 回归系数 标准误 Wald值 P值 OR值 95%CI
下限 上限
肌钙蛋白I 0.040 0.020 4.166 0.051 1.041 1.002 1.082
D-二聚体 0.000 0.000 3.013 0.083 1.000 1.000 1.000
白细胞计数 0.125 0.043 8.380 0.004 1.133 1.041 1.233
[1]
Wang X, Ren HM, Hu CY, et al. Predictors and in-hospital outcomes of preoperative acute kidney injury in patients with type A acute aortic dissection[J]. J Geriatr Cardiol, 2016, 13 (8): 679-684.
[2]
Nienaber CA, Clough RE. Management of acute aortic syndrome[J]. Lancet, 2015, 385 (9970): 800-811.
[3]
Myrmel T, Larsen M, Bartnes K. The International R-egistry of Acute Aortic Dissections (IRAD)-experiences from the first 20 years[J]. Scand Cardiovasc J, 2016, 50 (5-6): 329-333.
[4]
Ren YH, Liu F, Zhou XR, et al. Prognostic value of APACHEⅡ score in predicting in-hospital mortality for patients with type A acute aortic dissection[J]. J Clinical Cardiol, 2018, 34 (1): 61-65.
[5]
陆利冲，葛敏，王东进.脑脊液引流救治急性主动脉综合征引起的截瘫一例[J/CD].中华危重症医学杂志（电子版），2017，10（2）：136-139.
[6]
Yuan PJ, Wong WK. Acute myocardial infarction and concomitant stroke as the manifestations in a patient with type A aortic dissection: a case report with three years of follow-up[J]. Acta Cardiol Sin, 2018, 34 (1): 104-107.
[7]
Ranasinghe AM, Bonser RS. Biomarkers in acute ao-rtic dissection and other aortic syndromes[J]. J Am Coll Cardiol, 2010, 56 (19): 1535-1541.
[8]
Fan X, Huang B, Lu H, et al. Impact of admission white blood cell count on short- and long-term mortality in patients with type A acute aortic dissection: an observational study[J]. Medicine (Baltimore), 2015, 94 (42): e1761.
[9]
Tian L, Fan X, Zhu J, et al. Plasma D-dimer and in-hospital mortality in patients with Stanford type A acute aortic dissection[J]. Blood Coagul Fibrinolysis, 2014, 25 (2): 161-166.
[10]
Wen D, Du X, Dong JZ, et al. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection[J]. Heart, 2013, 99 (16): 1192-1197.
[11]
Cifani N, Proietta M, Tritapepe L, et al. Stanford-A acute aortic dissection, inflammation, and metalloproteinases: a review[J]. Ann Med, 2015, 47(6): 441-446.
[12]
Luo F, Zhou XL, Li JJ, et al. Inflammatory response is associated with aortic dissection[J]. Ageing Res Rev, 2009, 8 (1): 31-35.
[13]
del Porto F, Proietta M, Tritapepe L, et al. Inflammation and immune response in acute aortic dissection[J]. Ann Med, 2010, 42 (8): 622-629.
[14]
Sano M, Anzai J. The molecular mechanisms contr-ibuting to the pathophysiology of systemic inflammatory response after acute aortic dissection[J]. Nihon Rinsho Meneki Gakkai Kaishi, 2016, 39 (2): 91-95.
[15]
Gawinecka J, Schonrath F, von Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis[J]. Swiss Med Wkly, 2017 (147): w14489.
[16]
Chen ZR, Huang B, Lu HS, et al. Admission white blood cell count predicts short-term clinical outcomes in patients with uncomplicated Stanford type B acute aortic dissection[J]. J Geriatr Cardiol, 2017, 14 (1): 49-56.
[17]
Palmerini T, Mehran R, Dangas G, et al. Impact of leukocyte count on mortality and bleeding in patients with myocardial infarction undergoing primary percutaneous coronary interventions: analysis from the harmonizing outcome with revascularization and stent in acute myocardial infarction trial[J]. Circulation, 2011, 123 (24): 2829-2837.
[18]
Budzianowski J, Pieszko K, Burchardt P, et al. The role of hematological indices in patients with acute coronary syndrome[J]. Dis Markers, 2017: 3041565.
[19]
Arain FA, Khaleghi M, Bailey KR, et al. White blood cell count predicts all-cause mortality in patients with suspected peripheral arterial disease[J]. Am J Med, 2009, 122 (9): 874. e1-e7.
[20]
Libby P, Nahrendorf M, Swirski FK. Leukocytes link local and systemic inflammation in ischemic cardiovascular disease[J]. J Am Coll Cardiol, 2016, 67 (9): 1091-1103.
[21]
Yayla C, Gayretli Yayla K, Acar B, et al. White b-lood cell subtypes and Ratios in cardiovascular disease[J]. Angiology, 2017, 68 (7): 651.
[22]
Bhat T, Teli S, Rijal J, et al. Neutrophil to lym-phocyte ratio and cardiovascular diseases: a review[J]. Expert Rev Cardiovasc Ther, 2013, 11 (1): 55-59.
[23]
Kalkan ME, Kalkan AK, Gündes A, et al. Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection[J]. Perfusion. 2017, 32 (4): 321-327.
[24]
Liu N, Zhang W, Ma W, et al. Risk factors for h-ypoxemia following surgical repair of acute type A aortic dissection[J]. Interact Cardiovasc Thorac Surg, 2017, 24 (2): 251-256.
[1] 应康, 杨璨莹, 刘凤珍, 陈丽丽, 刘燕娜. 左心室心肌应变对无症状重度主动脉瓣狭窄患者的预后评估价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 581-587.
[2] 衣晓丽, 胡沙沙, 张彦. HER-2低表达对乳腺癌新辅助治疗疗效及预后的影响[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 340-346.
[3] 施杰, 李云涛, 高海燕. 腋窝淋巴结阳性Luminal A型乳腺癌患者新辅助与辅助化疗的预后及影响因素分析[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 353-361.
[4] 谭巧, 苏小涵, 侯令密, 黎君彦, 邓世山. 乳腺髓样癌的诊治进展[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 366-368.
[5] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[6] 栗艳松, 冯会敏, 刘明超, 刘泽鹏, 姜秋霞. STIP1在三阴性乳腺癌组织中的表达及临床意义研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 52-56.
[7] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[8] 潘冰, 吕少诚, 赵昕, 李立新, 郎韧, 贺强. 淋巴结清扫数目对远端胆管癌胰十二指肠切除手术疗效的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 608-612.
[9] 张其坤, 商福超, 李琪, 栗光明, 王孟龙. 联合脾切除对肝癌合并门静脉高压症患者根治性切除术后的生存获益分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 613-618.
[10] 钟广俊, 刘春华, 朱万森, 徐晓雷, 王兆军. MRI联合不同扫描序列在胃癌术前分期诊断及化疗效果和预后的评估[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 378-382.
[11] 胡宝茹, 尚乃舰, 高迪. 中晚期肝细胞癌的DCE-MRI及DWI表现与免疫治疗预后的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 399-403.
[12] 陆萍, 邹健. 凝血和纤维蛋白溶解标志物的动态变化对急性胰腺炎患者预后的评估价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 427-432.
[13] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[14] 王军, 刘鲲鹏, 姚兰, 张华, 魏越, 索利斌, 陈骏, 苗成利, 罗成华. 腹膜后肿瘤切除术中大量输血患者的麻醉管理特点与分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 844-849.
[15] 索利斌, 刘鲲鹏, 姚兰, 张华, 魏越, 王军, 陈骏, 苗成利, 罗成华. 原发性腹膜后副神经节瘤切除术麻醉管理的特点和分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 771-776.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号