急性主动脉夹层凝血功能及预后因素分析  

Analysis of coagulation function and prognostic factors of acute aortic dissection

作　　者：高伟波[1] 窦丽稳[1] 石茂静[1] 张海燕[1] 吴春波[1] 朱继红[1] Gao Weibo;Dou Liwen;Shi Maojing;Zhang Haiyan;Wu Chunbo;Zhu Jihong(Emergency Department,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院急诊科,100044

出　　处：《中华急诊医学杂志》2019年第11期1407-1412,共6页Chinese Journal of Emergency Medicine

摘　　要：目的探讨急性主动脉夹层(acute aortic dissection,AAD)患者的临床特征、凝血功能及预后相关因素。方法收集北京大学人民医院2008年11月至2016年1月急诊及住院的AAD患者的临床资料,分析其临床特征、凝血功能及预后相关因素。纳入者均经CT血管造影确诊,且发病时间在14 d以内。收集入院首次血常规、出凝血功能资料,记录手术干预方式、预后等资料。以是否发生弥散性血管内凝血(disseminated intravascular coagulation,DIC)、是否存活进行分组,比较组间差异。采用logistic回归分析院内死亡的影响因素。结果119例AAD患者的年龄为(52.9±14.2)岁,男女比例5.3∶1。疼痛为AAD患者最常见的临床表现,占90.0%以上,疼痛性质以转移性或扩展性疼痛多见。发生显性DIC 13例(10.9%),7例死亡(53.8%);DIC组与非DIC组比较,在中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、血小板(platelet,PLT)、纤维蛋白原(fibrinogen,FIB)、D-二聚体、纤维蛋白原降解产物(fibrinogen degradation products,FDP)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT),以及病死率方面,差异均有统计学意义(P<0.05)。死亡16例(13.4%)均为A型AAD,其中DIC 7例(43.8%);死亡组与存活组比较,在NLR、PLT、Fib、D-二聚体、FDP、PT、APTT,以及DIC比例和手术治疗方面,差异均有统计学意义(P<0.05)。Logistic回归分析发现,NLR、血小板计数是影响院内死亡的独立危险因素(P<0.05)。结论D-二聚体对AAD具有较高的诊断及预后价值,PLT活化和消耗量增加,则病死率增加,一旦发生DIC,预后极差;NLR、血小板计数是影响AAD患者院内死亡的独立危险因素。Objective To investigate the clinical characteristics,coagulation function and associated prognostic factors of acute aortic dissection.Methods The clinical data of 119 patients with acute aortic dissection(AAD)admitted to Beijing University People's Hospital from November 2008 to January 2016 were analyzed.All the participants were confirmed by computed tomography angiography,and the onset time was less than 14 days.Data of blood routine test,coagulation function at the first admission were collected,and surgical intervention and prognosis were recorded.All the patients,according to the prognosis,or whether disseminated intravascular coagulation(DIC)occurred,were divided into two groups,and the differences between the two groups were compared.Logistic regression analysis was applied to analyze independent risk factors related to in-hospital death in AAD patients.Results In 119 patients with AAD,the average age was(52.9±14.2)years,with a male/female ratio of 5.3:1.Pain was the most common clinical manifestation in patients with AAD,accounting for more than 90.0%.The nature of pain was mostly expansible and/or transitive pain.Dominant DIC occurred in 13 cases(10.9%),and 7 patients died(53.8%).There were significant differences between the DIC group and non-DIC group in neutrophil/lymphocyte ratio(NLR),platelet count,fibrinogen,D-dimer,FDP,PT,APTT and mortality rate(P<0.05).All the 16 patients in the death group were type A AAD,among which,7 patients(43.8%)developed with DIC.There were significant differences between the death group and survival group in NLR,platelet count,fibrinogen,D-dimer,FDP,PT,APTT,DIC proportion and surgical operation rate(P<0.05).Logistic regression analysis showed that NLR and platelet count were independent risk factors of in-hospital death(P<0.05).Conclusions D-dimer has a high diagnostic and prognosis value for AAD.The mortality increased with the activation and depletion of platelet.Once DIC occurs,the prognosis is extremely poor.NLR and platelet count are independent risk factors for

关 键 词：急性主动脉夹层 D-二聚体 中性粒细胞/淋巴细胞 弥散性血管内凝血 预后 

分 类 号：R73[医药卫生—肿瘤]