腺苷脱氨酶对急性Stanford A型主动脉夹层患者术后短期死亡风险预测的研究  

Predictive Value of Adenosine Deaminase for Early Postoperative Death in Patients with Acute Stanford Type A Aortic Dissection

作　　者：方敏 张新[1] 曹轶 吴云艳 赵永波[2] 马冬[1,3] FANG Min;ZHANG Xin;CAO Yi;WU Yunyan;ZHAO Yongbo;MA Dong(School of Public Health,North China University of Science and Technology,Tangshan 063210,Hebei,China;Cardiac Surgery Department,The Fourth Hospital of Hebei Medical University,Shijiazhuang 051000,Hebei,China;Department of Biochemistry and Molecular Biology,Key Laboratory of Neural and Vascular Biology,Ministry of Education,and Hebei Key Laboratory of Cardiovascular Homeostasis and Aging,Hebei Medical University,Shijiazhuang 050017,Hebei,China)

机构地区：[1]华北理工大学公共卫生学院,河北唐山063210 [2]河北医科大学第四医院心血管外科,河北石家庄051000 [3]神经与血管生物学教育部重点实验室,河北省心血管稳态与衰老重点实验室,河北医科大学基础生化所,河北石家庄050017

出　　处：《心血管病学进展》2025年第4期356-361,共6页Advances in Cardiovascular Diseases

基　　金：国家自然科学基金(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);河北省卫生健康委政府资助临床医学优秀人才培养项目(ZF2025226)。

摘　　要：目的探讨急性Stanford A型主动脉夹层(ATAAD)患者入院时腺苷脱氨酶(ADA)血清水平与术后30 d内全因死亡之间的关系。方法回顾性连续纳入2013年11月—2023年12月河北医科大学第四医院确诊为ATAAD并行手术治疗的234例患者,随访术后30 d全因死亡。logistic回归分析患者住院死亡的危险因素。ROC曲线评价ADA对ATAAD患者术后30 d死亡的预测作用。依据ADA最佳截断值分组并绘制Kaplan-Meier生存曲线。Cox回归亚组分析ADA与术后30 d死亡的关系。结果logistic回归分析结果显示,ATAAD患者入院时血清ADA水平与术后30 d死亡呈正相关(OR=1.487,95%CI 1.222~1.809)。AUC为0.744(95%CI 0.669~0.820,P<0.001),截断值为9.65 U/L,敏感度为57.1%,特异度为78.7%。Kaplan-Meier生存曲线显示入院高水平ADA患者术后30 d死亡率显著增加(log-rank检验,P<0.001)。亚组分析同样证实了入院高水平ADA与患者术后30 d死亡率相关。结论ATAAD患者入院血清ADA水平与术后短期死亡风险相关,对患者短期预后具有一定的预测价值。Objective To investigate the relationship between serum adenosine deaminase(ADA)levels at admission in acute Stanford type A aortic dissection(ATAAD)patients and all-cause mortality within 30 d after surgery.Methods A retrospective analysis of 234 patients who diagnosed with ATAAD admitted to The Fourth Hospital of Hebei Medical University between November 2013 and December 2023.The all-cause mortality within 30 d post-operation was followed up.Logistic regression analysis was used to identify independent risk factors for in-hospital mortality in ATAAD patients.ROC curve was used to assess the predictive value of ADA for 30 d mortality in ATAAD patients with the optimal cutoff value.Kaplan-Meier survival curves were plotted based on the optimal cutoff value,and the log-rank test was used to compare in-hospital mortality among groups with different ADA levels.Univariate Cox regression was employed for subgroup analysis of the relationship between ADA and mortality.Results The results of the multivariate logistic regression analysis revealed a positive correlation between serum ADA levels at admission and in-hospital mortality in patients with ATAAD(OR=1.487,95%CI 1.222~1.809).The AUC was 0.744(95%CI 0.669~0.820,P<0.001),with a cutoff value of 9.65 U/L,a sensitivity of 57.1%,and a specificity of 78.7%.KaplanMeier survival curve analysis showed a worse in-hospital survival with higher ADA levels.Univariate Cox regression subgroup analysis demonstrated an effectiveness of high ADA levels on mortality across different subgroups.Conclusion The ADA levels at admission in ATAAD patients may be a predictor associated with postoperative in-hospital mortality and the short-term prognosis.

关 键 词：急性Stanford A型主动脉夹层 腺苷脱氨酶 院内死亡 

分 类 号：R654.2[医药卫生—外科学]