血氯离子水平与急性A型主动脉夹层患者术后30 d内预后的相关性研究  

Relationship between Admission Serum Chloride Level and Postoperative 30-day Mortality in Patients with Acute Stanford Type A Aortic Dissection

作　　者：黄鹏飞 张云静 马冬 吴云艳[3] 赵永波[3] HUANG Pengfei;ZHANG Yunjing;MA Dong;WU Yunyan;ZHAO Yongbo(School of Public Health,North China University of Science and Technology,Tangshan 063000,China;The Key Laboratory of Neural and Vascular Biology,Ministry of Education,Hebei Medical University,Shijiazhuang 050017,China;Department of Cardiac Surgery,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]华北理工大学公共卫生学院,河北省唐山市063000 [2]河北医科大学神经与血管生物学教育部重点实验室,河北省石家庄市050017 [3]河北医科大学第四医院心外科,河北省石家庄市050011

出　　处：《中国全科医学》2023年第11期1330-1339,共10页Chinese General Practice

基　　金：国家自然科学基金资助项目(81700416,82270508);河北省自然科学基金面上项目(H2022206279);神经与血管生物学教育部重点实验室主任基金青年基金项目(NV20210006);河北省高等学校科学技术研究项目(QN2022164);2022河北省医学科学研究重点项目(20221293)。

摘　　要：背景急性A型主动脉夹层(ATAAD)是一种致命性疾病,快速、有效地识别ATAAD患者术后预后指标对其预后分层具有重要意义。血氯离子(Cl^(-))是人体重要的阴离子,影响多种疾病的发生、发展,但其与ATAAD的关系尚未完全明确。目的探讨ATAAD患者入院血Cl^(-)水平与术后30 d内全因死亡之间的关系,并分析ATAAD患者血Cl^(-)水平与血钠离子(Na^(+))水平之间的相关性。方法采用回顾性队列研究方法,连续纳入2016年2月至2019年12月河北医科大学第四医院经孙氏手术治疗的ATAAD患者206例,随访患者术后30 d内全因死亡及术后不良结局发生情况。根据入院血Cl^(-)水平三分位数将患者分为三组:T1组(血Cl^(-)≤102 mmol/L,n=69)、T2组(102 mmol/L<血Cl^(-)≤106 mmol/L,n=70)、T3组(血Cl^(-)>106 mmol/L,n=67),比较不同组间的临床基线资料、实验室检查结果、术中资料和术后30 d内的预后结局。绘制入院时血Cl^(-)、血Na^(+)水平对ATAAD患者术后30 d内死亡预测价值的受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC)、约登指数、灵敏度、特异度、最佳截断值。采用多因素Logistic回归分析探讨ATAAD患者术后30 d内全因死亡的影响因素。为了分析血Cl^(-)与血Na^(+)的关系,根据血Cl^(-)与血Na^(+)预测ATAAD患者术后30 d内全因死亡的最佳截断值(107 mmol/L和139 mmol/L)将ATAAD患者分为四组:高血Cl^(-)高血Na^(+)组(血Cl^(-)>107 mmol/L+血Na^(+)>139 mmol/L组,n=35),高血Cl^(-)低血Na^(+)组(血Cl^(-)>107 mmol/L+血Na^(+)≤139 mmol/L组,n=21),低血Cl^(-)高血Na^(+)组(血Cl^(-)≤107 mmol/L+血Na^(+)>139 mmol/L组,n=41),低血Cl^(-)低血Na^(+)组(血Cl^(-)≤107 mmol/L+血Na^(+)≤139 mmol/L组,n=109),比较各组间的全因死亡率和累积生存率。采用Kaplan-Meier法绘制不同血Cl^(-)水平,不同血Cl^(-)+血Na^(+)水平组ATAAD患者累积生存率的生存曲线,生存曲线比较采用Log-rank检验。采用Pearson相关性分析探讨血Cl^(-)Background Acute Stanford type A aortic dissection(ATAAD)is a fatal disease,and rapid and effective identification of its postoperative prognostic indicators is of great significance for stratifying patient prognosis.Serum chloride(Cl^(-))is an important anion in the body associating with the occurrence and development of many diseases,but the relationship between serum Cl^(-)and ATAAD is not completely clear.Objective To investigate the relationship of admission serum Cl^(-)level with postoperative 30-day all-cause mortality and admission serum sodium(Na^(+))in patients with ATAAD.Methods A retrospective cohort design was adopted.Two hundred and six consecutive ATAAD patients who underwent Sun's procedure from February 2016 to December 2019 in the Fourth Hospital of Hebei Medical University were selected.All-cause death and adverse events within postoperative 30 days of patients were followed up.The clinical baseline,laboratory and intraoperative data and postoperative 30-day prognosis were compared between tertile groups of admission serum Cl^(-)〔T1≤102 mmol/L(n=69),102<T2≤106 mmol/L(n=70),T3>106 mmol/L(n=67)〕.ROC curve analysis was used to measure the performance of admission serum Cl^(-)and Na^(+)in predicting all-cause mortality in ATAAD,in which the area under the ROC curve(AUC),the Youden index,sensitivity,specificity,and optimal cut-off value were calculated.Multivariate Logistic regression model was used to evaluate the association between admission serum Cl^(-)and postoperative 30-day all-cause mortality.For assessing the relationship between admission serum Cl^(-)and Na^(+),postoperative 30-day all-cause mortality and cumulative survival rate were compared between ATAAD patients in four groups divided by the optimal cut-off value of admission serum Cl^(-)(107 mmol/L)and Na^(+)(139 mmol/L):high Cl^(-)and high Na^(+)(Cl^(-)>107 mmol/L+Na^(+)>139 mmol/L,n=35),high Cl^(-)and low Na^(+)(Cl^(-)>107 mmol/L+Na^(+)≤139 mmol/L,n=21),low Cl^(-)and high Na^(+)(Cl^(-)≤107 mmol/L+Na^(+)>139 mmol/L,n=41),

关 键 词：主动脉疾病 主动脉夹层 血清氯离子 血清钠离子 急性A型主动脉夹层 全因死亡 预后 

分 类 号：R543.1[医药卫生—心血管疾病]