Yang Yang, Li Weihao, Liu Mingyuan, Zhang Xiaoming, Li Qingle
Department of Vascular Surgery, Peking University People's Hospital, Beijing, China.
J Thorac Dis. 2021 Feb;13(2):946-954. doi: 10.21037/jtd-20-2543.
Although aggressive medical treatment is recommended in patients with type B aortic intramural hematoma (IMH), a variety of aortic events can occur during the later period. For early identification of these patients, the present study was aimed at evaluating the prognostic validity of estimated glomerular filtration rate (eGFR) and the presence of proteinuria in type B aortic IMH.
Data of 61 patients with type B IMH in Peking University People's Hospital from January 2008 to December 2018 were retrospectively collected. The serum creatinine level and urine protein levels were measured at admission. And eGFR were calculated by the CKD-EPI equation. Adverse aortic-related events were defined as a composite of satisfaction of criteria for surgical conversion (with or without actual surgical intervention) and death from aortic rupture.
Initial eGFR was significantly different between patients with adverse aortic-related events and those without (P=0.003). On multivariate analysis, eGFR <90 mL/min/1.73 m (OR, 8.726; 95% CI: 1.711-46.144; P=0.009) and ULP (OR, 17.516; 95% CI: 3.322-92.258; P=0.001) were independent predictors of adverse aorta-related events. Furthermore, eGFR <90 mL/min/1.73 m and proteinuria (+) (OR, 8.344; P=0.030) had significantly greater rates of aortic-related events. In addition, eGFR <90 mL/min/1.73 m and proteinuria (+) had incremental prognostic value (C-statistic, 0.860, P=0.039) compared with ulcer-like projection (C-statistic, 0.815) alone.
Initial eGFR and presence of proteinuria were able to provide incremental prognostic information in addition to ulcer-like projection in patients with type B aortic IMH.
尽管推荐对B型主动脉壁内血肿（IMH）患者进行积极的药物治疗，但在后期仍可能发生多种主动脉事件。为了早期识别这些患者，本研究旨在评估估算肾小球滤过率（eGFR）和蛋白尿的存在对B型主动脉IMH患者的预后价值。
回顾性收集了2008年1月至2018年12月北京大学人民医院61例B型IMH患者的数据。入院时测量血清肌酐水平和尿蛋白水平。并通过CKD-EPI方程计算eGFR。不良主动脉相关事件定义为符合手术转换标准（无论是否进行实际手术干预）和主动脉破裂死亡的综合情况。
发生不良主动脉相关事件的患者与未发生此类事件的患者之间，初始eGFR存在显著差异（P = 0.003）。多因素分析显示，eGFR <90 mL/min/1.73 m²（比值比[OR]，8.726；95%置信区间[CI]：1.711 - 46.14；P = 0.009）和尿蛋白（ULP）（OR，17.516；95% CI：3.322 - 92.258；P = 0.001）是不良主动脉相关事件的独立预测因素。此外，eGFR <90 mL/min/1.73 m²且蛋白尿（+）（OR，8.344；P = 0.030）的患者发生主动脉相关事件的几率显著更高。此外，与单独的溃疡样突出（C统计量，0.815）相比，eGFR <90 mL/min/1.73 m²且蛋白尿（+）具有更高的预后价值（C统计量，0.860，P = 0.？39）。
在B型主动脉IMH患者中，除了溃疡样突出外，初始eGFR和蛋白尿的存在能够提供额外的预后信息。 （注：原文中“P = 0.？39”疑似有误，这里按原文翻译）
