APACHEⅡ评分联合血脂检测对Stanford A型主动脉夹层患者院内死亡的预测价值  

The application value of APACHEⅡscore combined with the detection of blood lipid level in predicting inhospital death of the patients with Stanford type A aortic dissection

作　　者：刘正[1] 朱涛[1] 霍强[1] 张明明[1] 李俊红[1] 俞国军[1] LIU Zheng;ZHU Tao;HUO Qiang(Department of Cardiac Surgery,The First Affiliated Hospital of Xinjiang Medical University,Xinjiang,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院心脏外科,乌鲁木齐市830000

出　　处：《河北医药》2021年第2期192-195,200,共5页Hebei Medical Journal

摘　　要：目的探究APACHEⅡ评分联合血脂水平检测对Stanford A型主动脉夹层(type A aortic dissection,TAAD)患者院内死亡的预测价值。方法回顾分析2017年1月至2019年6月收治的180例TAAD患者的临床资料,并根据患者是否发生院内死亡分为存活组123例和死亡组57例。比较2组患者基本临床资料、APACHEⅡ评分及血脂水平,采用单因素方差分析和Spearman相关系数分析APACHEⅡ评分及血脂水平与患者死亡的相关性,绘制ROC曲线分析APACHEⅡ评分联合血脂水平对患者死亡的预测效能,并进行Kappa一致性检验。结果Spearman相关性分析显示,APACHEⅡ评分与TAAD患者院内死亡呈显著正相关(r=0.426,P<0.001),HDL-C水平与TAAD患者院内死亡呈显著负相关(r=-0.374,P<0.001)。ROC曲线分析显示:APACHEⅡ评分与HDL-C水平单独预测TAAD患者院内死亡的AUC分别为0.783、0.774,均>0.5,均有诊断效能,Cut-off值分别为8.43分、0.92 mmol/L,此时灵敏度分别为85.03%、83.25%;二者联合预测时AUC为0.908(95%CI:0.856,0.958),敏感度为92.60%,均明显高于两者单独预测(P<0.01)。Kappa一致性检验显示:APACHEⅡ评分联合HDL-C水平预测TAAD患者院内死亡与患者实际临床结局具有较高的一致性(Kappa值=0.744,P<0.001)。结论APACHEⅡ评分联合HDL-C水平对Stanford A型主动脉夹层患者院内死亡具有显著预测效能,敏感度高达92.60%,预测结果与患者实际临床结局一致性显著,可作为TAAD患者院内死亡风险的重要评估指标。Objective To investigate the application value of APACHEⅡscore combined with detection of blood lipid level in predicting inhospital death of the patients with Stanford type A aortic dissection(TAAD).Methods The clinical data about 180 patients with TAAD who were treated in our hospital from January 2017 to June 2019 were retrospectively analyzed.The patients were divided into survival case group(n=123)and death case group(n=57).The basic clinical data,APACHEⅡscore and blood lipid levels of the patients were observed and compared between the two groups.Moreover,one-way anova and Spearman correlation coefficient were used to analyze the correlation between APACHEⅡscore,blood lipid level and patient mortality.Furthermore,ROC curve was used to analyze the prediction efficiency of APACHEⅡscore combined with blood lipid level in patient mortality.In addition,Kappa identity test was conducted.Results Spearman correlation analysis showed that APACHEⅡscores were positively correlated with hospital mortality in patients with TAAD(P<0.01),however,the levels of HDL-C were negatively correlated with hospital mortality in patientts with TAAD patients(P<0.01).ROC curve analysis showed that the APACHEⅡscores and the AUC predicting the hospital death in patients with TAAD at the level of HDL-C alone were 0.783 and 0.774,respectively,both>0.5,with diagnostic efficacy.The cut off values were 8.43mmol/L and 0.92mmol/L,respectively and the sensitivities were 85.03%and 83.25%,respectively.Moreover,the combined AUC was 0.908(95%CI:0.856,0.958)and the sensitivity was 92.60%,which were significantly higher than those by single prediction(P<0.01).In addition,Kappa identity test showed that the APACHEⅡscores combined with HDL-C level detection in predicting the hospital death of patients with TAAD were highly consistent with the actual clinical outcome of the patients(Kappa value=0.774,P<0.01).Conclusion APACHEⅡscore combined with HDL-C level detection has significant predictive effects for the hospital mortality of patien

关 键 词：APACHEⅡ 血脂、HDL-C、Stanford A型主动脉夹 院内死亡 

分 类 号：R543.1[医药卫生—心血管疾病]