术前血清sCD163、sTWEAK水平与Stanford A型主动脉夹层动脉瘤患者预后的关系  

Relationship between preoperative serum sCD163 and sTWEAK levels and prognosis in patients with Stanford type A aortic dissecting aneurysm

作　　者：崔荣敏[1] 龚琪[1] 王哲[1] 万翠翠 Cui Rongmin;Gong Qi;Wang Zhe;Wan Cuicui(Department of Cardiac Surgery,the Fourth Hospital of Hebei Medical University,Hebei Province,Shijiazhuang 050010,China)

机构地区：[1]河北医科大学第四医院心外科,石家庄050010

出　　处：《疑难病杂志》2022年第9期896-900,906,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省医学科学研究课题计划项目(20190714)。

摘　　要：目的分析术前血清可溶性血红蛋白清道夫受体(sCD163)、可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)水平与Stanford A型主动脉夹层动脉瘤患者预后的关系。方法选择2016年1月—2019年3月河北医科大学第四医院心外科收治Stanford A型主动脉夹层动脉瘤患者143例作为观察组,根据术后3年随访结果将患者分为存活亚组115例,死亡亚组28例;另选择同期医院体检健康者140例作为健康对照组。比较各组血清sCD163、sTWEAK水平;Pearson法分析Stanford A型主动脉夹层动脉瘤患者术前血清sCD163与sTWEAK水平的相关性;Logistic回归分析影响Stanford A型主动脉夹层动脉瘤患者死亡的危险因素;受试者工作特征曲线(ROC)分析术前血清sCD163、sTWEAK对Stanford A型主动脉夹层动脉瘤患者死亡的预测价值。结果死亡亚组高血压比例、术前血清低密度脂蛋白胆固醇(LDL-C)、心肌肌钙蛋白I(cTnI)、D-二聚体(D-D)水平均显著高于存活亚组[χ^(2)(t)/P=4.481/0.034、2.441/0.016、2.181/0.031、7.571/<0.001];观察组术前血清sCD163、sTWEAK水平均显著高于健康对照组(t/P=33.220/<0.001、25.643/<0.001);死亡亚组术前血清sCD163、sTWEAK水平均显著高于存活亚组(t/P=7.871/<0.001,8.097/<0.001);Stanford A型主动脉夹层动脉瘤患者术前血清sCD163与sTWEAK水平呈正相关(r=0.449,P<0.001);术前LDL-C、D-二聚体、sCD163、sTWEAK水平升高是影响Stanford A型主动脉夹层动脉瘤患者死亡的危险因素[OR(95%CI)=3.066(2.125~4.423)、2.090(1.215~3.596)、2.396(1.381~4.156)、2.979(2.183~4.064)];术前血清sCD163、sTWEAK及二者联合预测Stanford A型主动脉夹层动脉瘤患者死亡的曲线下面积分别为0.860、0.887、0.935,二者联合预测效能高于单项预测(Z/P=1.901/0.028、2.331/0.019)。结论Stanford A型主动脉夹层动脉瘤患者术前血清sCD163、sTWEAK水平升高,是影响患者死亡的危险因素,对患者死亡有一定预测价值。Objective To analyze The relationship between preoperative serum soluble hemoglobin scavenger receptor(sCD163)and soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK)and prognosis of patients with Stanford type A aortic dissection.Methods From January 2016 to March 2019,143 patients with Stanford type A aortic dissecting aneurysm admitted to the Department of Cardiac Surgery of the Fourth Hospital of Hebei Medical University were selected as the observation group.According to the 3-year follow-up results,the patients were divided into 115 survival subgroups.28 patients died in the subgroup;another 140 healthy people who underwent physical examination in the hospital during the same period were selected as the healthy control group.Comparison of serum sCD163 and sTWEAK levels in each group;Pearson analysis of the correlation between preoperative serum sCD163 and sTWEAK levels in patients with Stanford type A aortic dissection;Logistic regression analysis of the risk factors for death in patients with Stanford type A aortic dissection;The predictive value of preoperative serum sCD163 and sTWEAK in patients with Stanford type A aortic dissecting aneurysm was analyzed by the operator operating characteristic curve(ROC).Results The proportion of hypertension,preoperative serum low-density lipoprotein cholesterol(LDL-C),cardiac troponin I(cTnI),and D-dimer levels in the death subgroup were significantly higher than those in the survival subgroup[χ^(2)(t)/P=4.481/0.034,2.441/0.016,2.181/0.031,7.571/<0.001];the preoperative serum sCD163 and sTWEAK levels in the observation group were significantly higher than those in the healthy control group(t/P=33.220/<0.001,25.643/<0.001);The preoperative serum sCD163 and sTWEAK levels in the group were significantly higher than those in survival subgroup(t/P=7.871/<0.001,8.097/<0.001);preoperative serum sCD163 and sTWEAK levels in patients with Stanford type A aortic dissection were positively correlated(r=0.449,P<0.001);preoperative LDL C,D dimer,sCD163,and sTWEAK

关 键 词：主动脉夹层动脉瘤 Stanford A型 可溶性血红蛋白清道夫受体 可溶性肿瘤坏死因子样凋亡弱诱导因子 预后 

分 类 号：R543.16[医药卫生—心血管疾病]