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急性A型主动脉夹层术后乳酸水平及恢复与预后的关系

王雪 邓超 郭锋伟 曹先通 杨阳 高珩 闫炀

王雪, 邓超, 郭锋伟, 曹先通, 杨阳, 高珩, 闫炀. 急性A型主动脉夹层术后乳酸水平及恢复与预后的关系[J]. 心脏杂志, 2023, 35(1): 57-61, 66. doi: 10.12125/j.chj.202201036
引用本文: 王雪, 邓超, 郭锋伟, 曹先通, 杨阳, 高珩, 闫炀. 急性A型主动脉夹层术后乳酸水平及恢复与预后的关系[J]. 心脏杂志, 2023, 35(1): 57-61, 66. doi: 10.12125/j.chj.202201036
Xue WANG, Chao DENG, Feng-wei GUO, Xian-tong CAO, Yang YANG, Heng GAO, Yang YAN. Relationship between lactate level, recovery and prognosis after acute type A aortic dissection[J]. Chinese Heart Journal, 2023, 35(1): 57-61, 66. doi: 10.12125/j.chj.202201036
Citation: Xue WANG, Chao DENG, Feng-wei GUO, Xian-tong CAO, Yang YANG, Heng GAO, Yang YAN. Relationship between lactate level, recovery and prognosis after acute type A aortic dissection[J]. Chinese Heart Journal, 2023, 35(1): 57-61, 66. doi: 10.12125/j.chj.202201036

急性A型主动脉夹层术后乳酸水平及恢复与预后的关系

doi: 10.12125/j.chj.202201036
详细信息
    作者简介:

    王雪,主治医师,硕士 Email:wangxue405@163.com

    通讯作者:

    闫炀,主任医师,主要从事心脏瓣膜病和重症临床研究 Email:yyang376@126.com

  • 中图分类号: R543.1

Relationship between lactate level, recovery and prognosis after acute type A aortic dissection

  • 摘要:   目的  分析急性A型主动脉夹层(acute Stanford type-A aortic dissection,aTAAD)术后乳酸水平及恢复与预后的关系。  方法  对2020年1月至2021年6月在西安交通大学第一附属医院心血管外科住院行外科手术治疗的aTAAD患者进行筛选并随访半年,共纳入患者293例,其中仅行手术治疗患者263例,随访半年,失访4例,最终纳入符合研究标准的患者259例患者,其中男性176例,女性83例,年龄(51±12)岁,按照随访截止是否死亡分为死亡组和存活组,死亡组患者59例,存活组200例。所有患者均检测术后(0、4、8、12、16、20与24)h的乳酸水平,计算乳酸恢复至正常水平所需时间,术前空腹抽血留取生化、血常规及凝血等指标,记录超声心动图等指标 。  结果  通过不同指标单因素和多因素COX比较发现,术后24 h乳酸[HR 0.805,95% CI (0.708,0.916),P<0.01]、乳酸恢复至正常水平所需时间[HR 1.066,95% CI (1.039,1.094),P<0.01]、DD[HR 1.052,95% CI (1.023,1.082),P<0.01]及年龄[HR 1.047,95% CI (1.015,1.081),P<0.01]均为影响aTAAD患者的影响因素。乳酸恢复正常水平所需时间的ROC曲线下面积(AUC)为0.789[95% CI (0.656,0.801)],灵敏度为83.1%,特异度为59.5% (P<0.01),通过比较曲线下面积发现乳酸恢复正常水平所需时间预测价值大于其余指标。将患者分为乳酸恢复至正常水平所需时间<21 h组和乳酸恢复至正常水平所需时间>21 h组,进一步绘制影响aTAAD患者预后的生存曲线,发现乳酸恢复至正常水平所需时间<21 h组患者存活率大于乳酸恢复至正常水平所需时间>21 h组,且Log Rank检验P<0.01。  结论  aTAAD术后24 h乳酸和乳酸恢复至正常水平所需时间是影响长期预后的独立影响因素,且乳酸恢复至正常水平所需时间预测价值优于单一乳酸水平,是最佳的预后指标,为临床提前干预和治疗提供依据。

     

  • 图  1  不同因素对aTAAD患者预后的ROC分析

    图  2  乳酸恢复至正常水平所需时间生存曲线

    表  1  不同指标对aTAAD患者预后的COX分析

    指标单因素COX分析多因素COX分析
    HR95%CIPHR95%CIP
    术后0 h乳酸(mmol/L)1.1161.064-1.1710.0001.0550.951-1.1700.309
    术后4 h乳酸(mmol/L)1.1451.092-1.2010.0000.9810.837-1.1490.812
    术后8 h乳酸(mmol/L)1.1181.072-1.1660.0000.9160.773-1.0860.311
    术后12 h乳酸(mmol/L)1.1361.091-1.1830.0001.0110.826-1.2370.919
    术后16 h乳酸(mmol/L)1.1481.103-1.1960.0001.0670.912-1.2490.417
    术后20 h乳酸(mmol/L)1.0711.048-1.0940.0001.0370.991-1.0850.117
    术后24 h乳酸(mmol/L)1.1701.110-1.2330.0000.8050.708-0.9160.001
    最高乳酸水平(mmol/L)1.1481.093-1.2050.0001.1370.934-1.3860.201
    乳酸恢复正常水平时间(h)1.0551.041-1.0690..0001.0661.039-1.0940.000
    Pro-BNP(pg/ml)1.0001.000-1.0000.1071.0001.000-1.0000.518
    CRP(mg/L)1.0040.999-1.0090.0001.0061.000-1.0120.068
    AST(U/L)0.9990.997-1.0020.5710.9970.992-1.0020.291
    尿素(mmol/L)1.0220.988-1.0570.2130.9540.857-1.0630.396
    肌酐(μmol/L)1.0011.000-1.0020.0901.0030.998-1.0080.210
    D二聚体(mg/L)1.0261.017-1.0360.0001.0521.023-1.0820.000
    年龄1.0601.034-1.0860.0001.0471.015-1.0810.004
    肌酐清除率(ml/min)0.9870.981-0.9930.0000.9940.984-1.0040.213
    下载: 导出CSV
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出版历程
  • 收稿日期:  2022-01-10
  • 录用日期:  2022-04-26
  • 修回日期:  2022-03-28
  • 刊出日期:  2023-02-25

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