Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
J Thorac Cardiovasc Surg. 2014 Jan;147(1):326-31. doi: 10.1016/j.jtcvs.2012.11.030. Epub 2012 Dec 6.
The appropriate management of aortic intramural hematoma is still controversial, because a variety of aortic events can arise during follow-up in some patients. However, simplified identification of these patients remains challenging. The present study aimed to determine the prognostic significance of serial C-reactive protein measurements for the prediction of adverse events in patients with acute aortic intramural hematoma.
A total of 180 patients with aortic intramural hematoma were retrospectively reviewed. The C-reactive protein data were obtained at admission and 2 days, 1 week, and 2 weeks from the onset, and the maximum value was obtained during the acute phase. Adverse aorta-related events were defined by a composite of aortic rupture, aortic aneurysm, and surgical or endovascular aortic repair.
The C-reactive protein value was 3.0 ± 4.6, 8.7 ± 5.9, 9.0 ± 5.5, and 5.7 ± 4.5 mg/dL on admission and 2 days, 1 week, and 2 weeks from the onset, respectively. The maximal value of C-reactive protein was 12.4 ± 6.3 mg/dL at a mean of 4 days from the onset. Patients with elevated C-reactive protein levels (≥7.2 mg/dL) at 2 weeks had significantly greater rates of aorta-related events (P < .001). On multivariate analysis, an elevated C-reactive protein level at 2 weeks (hazard ratio, 3.16; P < .001) and the development of an ulcer-like projection (hazard ratio, 2.68; P = .002) were independent predictors of adverse aorta-related events. In addition, an elevated C-reactive protein level at 2 weeks had incremental value compared with the development of an ulcer-like projection (chi-square, 16.94 for ulcer-like projection only vs 34.32 with the addition of C-reactive protein at 2 weeks, P < .001).
C-reactive protein was a simple and useful marker providing incremental prognostic information compared with the development of an ulcer-like projection in patients with aortic intramural hematoma.
主动脉壁内血肿的适当治疗仍存在争议，因为在一些患者的随访过程中可能会发生多种主动脉事件。然而，简化这些患者的识别仍然具有挑战性。本研究旨在确定连续 C 反应蛋白测量对预测急性主动脉壁内血肿患者不良事件的预后意义。
回顾性分析了 180 例主动脉壁内血肿患者。C 反应蛋白数据在入院时和发病后 2 天、1 周和 2 周获得，急性期获得最大值。不良主动脉相关事件定义为主动脉破裂、主动脉瘤和外科或血管内主动脉修复的复合事件。
入院时和发病后 2 天、1 周和 2 周的 C 反应蛋白值分别为 3.0±4.6、8.7±5.9、9.0±5.5 和 5.7±4.5mg/dL。C 反应蛋白的最大值为 12.4±6.3mg/dL，平均发病后 4 天。发病后 2 周 C 反应蛋白水平升高（≥7.2mg/dL）的患者主动脉相关事件发生率显著更高（P<.001）。多变量分析显示，发病后 2 周 C 反应蛋白水平升高（危险比，3.16；P<.001）和溃疡样突起的发展（危险比，2.68；P=.002）是不良主动脉相关事件的独立预测因素。此外，与溃疡样突起的发展相比，发病后 2 周 C 反应蛋白水平升高具有增量价值（仅溃疡样突起的卡方值为 16.94，而添加发病后 2 周 C 反应蛋白的卡方值为 34.32，P<.001）。
C 反应蛋白是一种简单而有用的标志物，与主动脉壁内血肿患者溃疡样突起的发展相比，提供了额外的预后信息。
