冰冻象鼻术治疗急性I型主动脉夹层的炎症轨迹与抗炎药物治疗

Inflammatory Trajectory and Anti-Inflammatory Pharmacotherapy in Frozen Elephant Trunk-Treated Acute Type I Aortic Dissection.

作者信息

Liu Hong, Diao Yi-Fei, Xu Xu-Fan, Qian Si-Chong, Shao Yong-Feng, Zhao Sheng, Sun Li-Zhong, Zhang Hong-Jia

机构信息

Department of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

出版信息

J Soc Cardiovasc Angiogr Interv. 2024 Apr 5;3(7):101935. doi: 10.1016/j.jscai.2024.101935. eCollection 2024 Jul.

DOI:10.1016/j.jscai.2024.101935

PMID:39132007

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11307765/

Abstract

BACKGROUND

Acute DeBakey type I aortic dissection is associated with high morbidity and mortality. Little is known regarding the role of leukocyte trajectory in prognosis.

METHODS

We included adult acute DeBakey type I aortic dissection patients with emergency frozen elephant trunk and total arch replacement in 2 cardiovascular centers (2020-2022). We used latent class mixed model to group patients according to their leukocyte patterns from hospital admission to the first 5 days after surgery. We investigated the association of leukocyte trajectory and 30-day and latest follow-up mortality (October 31, 2023), exploratorily analyzing the effects of ulinastatin treatment on outcome.

RESULTS

Of 255 patients included, 3 distinct leukocyte trajectories were identified: 196 in group I (decreasing trajectory), 34 in group II (stable trajectory), and 25 in group III (rising trajectory). Overall, 30-day mortality was 25 (9.8%), ranging from 8.2% (16/196) in group I, 8.8% (3/34) in group II, to 24.0% (6/25) in group III ( for trend = .036). Group III was associated with higher mortality both at 30 days (adjusted hazard ratio, 3.260; 95% CI, 1.071-9.919; = .037) and at the last follow-up (adjusted hazard ratio, 2.840; 95% CI, 1.098-7.345; = .031) compared with group I.

CONCLUSIONS

Distinct and clinically relevant groups can be identified by analyzing leukocyte trajectories, and a rising trajectory was associated with higher short-term and midterm mortality.

摘要

背景

急性德巴基I型主动脉夹层的发病率和死亡率都很高。关于白细胞轨迹在预后中的作用，人们了解甚少。

方法

我们纳入了2个心血管中心（2020年至2022年）接受急诊冰冻象鼻术和全弓置换术的成年急性德巴基I型主动脉夹层患者。我们使用潜在类别混合模型，根据患者从入院到术后第5天的白细胞模式对其进行分组。我们研究了白细胞轨迹与30天及最新随访死亡率（2023年10月31日）之间的关联，并探索性分析乌司他丁治疗对预后的影响。

结果

在纳入的255例患者中，识别出3种不同的白细胞轨迹：I组196例（下降轨迹），II组34例（稳定轨迹），III组25例（上升轨迹）。总体而言，30天死亡率为25例（9.8%），范围从I组的8.2%（16/196）、II组的8.8%（3/34）到III组的24.0%（6/25）（趋势检验P = 0.036）。与I组相比，III组在30天时（调整后风险比，3.260；95%置信区间，1.071 - 9.919；P = 0.037）和最后随访时（调整后风险比，2.840；95%置信区间，1.098 - 7.345；P = 0.031）的死亡率更高。