急性主动脉夹层后急性呼吸窘迫综合征患者的凝血功能障碍：一项前瞻性观察研究。
Coagulation Disorders in Patients With Acute Respiratory Distress Syndrome Following Acute Aortic Dissection: A Prospective Observational Study.
作者信息
Liu Maomao, Wang Tengke, Yu Yan, Lu Xuran, Chen Zheyuan, Yu Li, Cheng Sihao, Li Lingru, Wang Liangshan, Liu Nan
机构信息
Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
出版信息
Rev Cardiovasc Med. 2025 Aug 25;26(8):36372. doi: 10.31083/RCM36372. eCollection 2025 Aug.
BACKGROUND
Coagulation disorders are potentially one of the most important pathogeneses of acute respiratory distress syndrome (ARDS) following acute type A aortic dissection (ATAAD). This study aimed to determine whether aortic dissection singularly and cardiopulmonary bypass (CPB) surgery can activate coagulation pathways, promoting ARDS development in patients with ATAAD.
METHODS
A total of 450 patients who received treatment at Beijing Anzhen Hospital, Capital Medical University, between March 2023 and February 2024 were consecutively enrolled in this prospective cohort study. We analyzed the clinical factors and measured serum coagulation biomarkers by enzyme-linked immunosorbent assay (ELISA) among patients with ATAAD, aortic aneurysm (AA), or unstable angina (UA). Logistic regression, two-way analysis of variance (ANOVA), and Spearman's correlation analysis were performed. Furthermore, the patients with ATAAD were divided into ARDS (based on chest radiographic findings and an oxygenation index ≤300 mmHg) and non-ARDS groups for subgroup comparisons.
RESULTS
The incidence of postoperative ARDS among patients with ATAAD was 20.7% (13.3% in the AA group and 7.3% in the UA group). Preoperatively, prothrombin time (PT) was longer in patients with ATAAD than in those with AA or UA ((odds ratio (OR): 12.0, 95% confidence interval (CI): 11.5-12.6) vs. (OR: 11.4, 95% CI: 10.9-12.1) vs. (OR: 11.2, 95% CI: 10.8-11.6), respectively; < 0.001). The D-dimer levels, fibrin degradation products (FDPs), factor XIIa, and factor VIII-Ag (FVIII-Ag) were significantly elevated preoperatively and postoperatively in patients with ATAAD. The FDP levels in the ATAAD subgroup immediately after surgery were significantly higher in the ARDS group compared with those in the non-ARDS group (OR: 2.26, 95% CI: 1.13-4.54; = 0.022). In addition, a negative correlation existed between the FXII level (correlation coefficient r = -0.682, = 0.043) at 24 hours after surgery and the oxygenation index.
CONCLUSION
Coagulation activation may be caused by aortic dissection singularly and CPB, which promotes postoperative ARDS in patients with ATAAD.
背景
凝血功能障碍可能是急性A型主动脉夹层（ATAAD）后急性呼吸窘迫综合征（ARDS）最重要的发病机制之一。本研究旨在确定单纯主动脉夹层和体外循环（CPB）手术是否会激活凝血途径，从而促进ATAAD患者发生ARDS。
方法
本前瞻性队列研究连续纳入了2023年3月至2024年2月期间在首都医科大学附属北京安贞医院接受治疗的450例患者。我们分析了ATAAD、主动脉瘤（AA）或不稳定型心绞痛（UA）患者的临床因素，并通过酶联免疫吸附测定（ELISA）检测血清凝血生物标志物。进行了逻辑回归、双向方差分析（ANOVA）和Spearman相关性分析。此外，将ATAAD患者根据胸部X线检查结果和氧合指数≤300 mmHg分为ARDS组和非ARDS组进行亚组比较。
结果
ATAAD患者术后ARDS的发生率为20.7%（AA组为13.3%，UA组为7.3%）。术前，ATAAD患者的凝血酶原时间（PT）比AA或UA患者更长（分别为比值比（OR）：12.0，95%置信区间（CI）：11.5 - 12.6） vs. （OR：11.4，95% CI：10.9 - 12.1） vs. （OR：11.2，95% CI：10.8 - 11.6）；P < 0.001）。ATAAD患者术前和术后的D - 二聚体水平、纤维蛋白降解产物（FDPs）、因子XIIa和因子VIII - Ag（FVIII - Ag）均显著升高。与非ARDS组相比，ARDS组术后即刻的ATAAD亚组FDP水平显著更高（OR：2.26，95% CI：1.13 - 4.54；P = 0.022）。此外，术后24小时的FXII水平与氧合指数之间存在负相关（相关系数r = -0.682，P = 0.043）。
结论
单纯主动脉夹层和CPB可能导致凝血激活，从而促进ATAAD患者术后发生ARDS。
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