Kimura Satoshi, Sato Hiroaki, Shimajiri Shohei, Nakayama Toshiyuki
Department of Clinical Pathology, Kitakyushu City Yahata Hospital, Kitakyushu, Japan.
Department of Pathology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Am Heart J Plus. 2025 Mar 6;52:100521. doi: 10.1016/j.ahjo.2025.100521. eCollection 2025 Apr.
Acute thoracic aortic dissection (ATAD) has a high mortality rate. Factors that contribute to its onset include the environment, genetic factors, and infectious diseases. Recently, the presence of monocytes/macrophages has been suggested to attract inflammatory and immune cells to lesions. This, together with levels of D-dimer, brain natriuretic peptide (BNP), aspartate aminotransferase (AST), and lactate dehydrogenase (LD), may be useful in predicting a prognosis for ATAD. This study examined the relationship between a combination of such laboratory data and prognosis in ATAD.
A single-center retrospective study. The association between early mortality from ATAD and laboratory data was statistically investigated.
Treatment strategies were at the discretion of each attending physician.
A total of 118 patients with ATAD (59 early deaths and 59 survivors).
The value of D-dimer, BNP, AST, and LD levels, and the peripheral blood monocyte ratio as scores for the early prediction of a prognosis without requiring advanced testing equipment.
The AST/LD, D-dimer, and BNP levels were significantly elevated in those who died prematurely. In contrast, the monocyte ratio in the peripheral blood leukocyte fraction was significantly decreased. The AST/LD, which was associated with cardiac troponin I, was the most significant variable. An average positive value from each test was defined as an acute aortic dissection prognostic score (AAD-PS). The area under the curve on the receiver operating characteristic was 0.895.
In ATAD patients, the AAD-PS may be a potentially new and useful test item for predicting prognosis.
急性胸主动脉夹层（ATAD）死亡率很高。导致其发病的因素包括环境、遗传因素和传染病。最近，有人提出单核细胞/巨噬细胞的存在会吸引炎症和免疫细胞至病变部位。这一点，连同D - 二聚体、脑钠肽（BNP）、天冬氨酸转氨酶（AST）和乳酸脱氢酶（LD）水平，可能有助于预测ATAD的预后。本研究探讨了这些实验室数据的组合与ATAD预后之间的关系。
单中心回顾性研究。对ATAD早期死亡率与实验室数据之间的关联进行了统计学调查。
治疗策略由每位主治医生自行决定。
总共118例ATAD患者（59例早期死亡和59例幸存者）。
D - 二聚体、BNP、AST和LD水平的值，以及外周血单核细胞比例，作为无需先进检测设备即可早期预测预后的评分指标。
过早死亡者的AST/LD、D - 二聚体和BNP水平显著升高。相比之下，外周血白细胞部分中的单核细胞比例显著降低。与心肌肌钙蛋白I相关的AST/LD是最显著的变量。将每项检测的平均正值定义为急性主动脉夹层预后评分（AAD - PS）。受试者工作特征曲线下面积为0.895。
在ATAD患者中，AAD - PS可能是一种潜在的、用于预测预后的新的有用检测项目。
