急性主动脉夹层患者院内死亡的危险因素分析  

Risk factors for in-hospital mortality in patients with acute aortic dissection

作　　者：马倩倩 王淑红[1] 丁琦 冯晔子 黄新新 张欢欢 MA Qianqian;WANG Shu-hong;DING Qi;FENG Yezi;HUANG Xinxin;ZHANG Huanhuan(Department of Cardiology,Zhengzhou NO.7 People's Hospital,Zhengzhou 450016,China)

机构地区：[1]郑州市第七人民医院心内科,450016

出　　处：《心肺血管病杂志》2021年第5期468-472,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨急性主动脉夹层患者的临床特征及院内死亡的相关危险因素。方法:回顾性收集2018年5月至2020年7月,郑州市第七人民医院主动脉夹层住院患者205例病历资料。根据患者住院转归,分为存活组(n=175)和死亡组(n=30),比较两组患者的一般资料、既往病史、治疗方式以及实验室指标等,采用多因素Logistic回归分析探讨主动脉夹层患者院内死亡危险因素,并应用ROC曲线评价其预测价值。结果:主动脉夹层患者的院内病死率为14.6%(30/205)。死亡组的心率、Stanford A型主动脉夹层比例、非手术治疗比例、NLR、D-Dimer水平均明显高于存活组,PLT计数低于存活组(P均<0.05);多因素Logistic回归分析显示:心率(OR=1.063,95%CI:1.030~1.098,P<0.001)、A型夹层(OR=4.809,95%CI:1.341~17.246,P=0.016)、NLR(OR=1.179,95%CI:1.095~1.269,P<0.001)和D-Dimer(OR=1.186,95%CI:1.006~1.399,P=0.042)是主动脉夹层患者死亡的危险因素,而手术治疗(OR=0.187,95%CI:0.055~0.632,P=0.007)和入院时PLT计数高(OR=0.981,95%CI:0.970~0.993,P=0.001)是患者院内死亡的保护因素。ROC曲线显示NLR预测患者院内死亡的AUC为0.839(95%CI:0.775~0.903,P<0.001),最佳临界点为9.05,敏感度及特异度分别为93.3%和68.0%。D-Dimer水平预测患者院内死亡的AUC为0.725(95%CI:0.600~0.850,P=0.002),最佳临界点为3.66μg/mL,敏感度及特异度分别为78.9%和62.7%。结论:心率增快、A型夹层、高NLR和D-Dimer水平是主动脉夹层患者院内死亡的独立危险因素,而手术治疗、入院时PLT计数高是患者院内死亡的保护因素,NLR和D-Dimer对主动脉夹层患者院内死亡具有较好的预测价值。Objective: To investigate the clinical characteristics and risk factors of in-hospital mortality in patients with acute aortic dissection(AAD). Methods: A total of 205 AAD patients, who hospitalized in Zhengzhou Seventh People’s Hospital from May 2018 to July 2020, were included in this retrospective study. According to the hospital outcome, the patients were divided into survival group(n=175) and non-survival group(n=30). The general information, past medical history, treatment method and laboratory indicators of the two groups were analyzed. Multivariate Logistic regression analysis was used to explore the risk factors of in-hospital death in AAD patients, and the ROC curve was used to evaluate the predictive value. Results: The total in-hospital mortality of AAD patients was 14.6%(30/205). The heart rate, Stanford type A AAD, percent of non-surgical treatment, levels of NLR and D-Dimer were significantly higher, and the platelet count on admission was significantly lower in non-survival group than in survival group(all P<0.05);Multivariate logistic regression analysis showed that increased heart rate on admission(OR=1.063, 95%CI: 1.030-1.098, P<0.001), type A dissection(OR=4.809, 95%CI: 1.341-17.246, P=0.016), high NLR(OR=1.179, 95%CI: 1.095-1.269, P<0.001) and D-Dimer levels(OR=1.186, 95%CI: 1.006-1.399, P=0.042) were the independent risk factors for in-hospital mortality, while surgical treatment(OR=0.187, 95%CI: 0.055-0.632, P=0.007) and high platelet count on admission(OR=0.981, 95%CI: 0.970-0.993, P=0.001) were the protective factors for in-hospital mortality of AAD patients. The area under the work characteristic curve(AUC) predicted by NLR level was 0.839(95% CI: 0.775-0.903, P< 0.001). The optimum critical point was 9.05, the sensitivity and specificity were 93.3% and 68.0%, respectively. The AUC of D-Dimer was 0.725(95% CI: 0.600-0.850, P=0.002). The optimal cut-off point was 3.66 μg/mL. The sensitivity and specificity were 78.9% and 62.7%, respectively. Conclusions: Increased heart rate on admissi

关 键 词：急性主动脉夹层 院内死亡 危险因素 

分 类 号：R54[医药卫生—心血管疾病]