急性A型主动脉夹层患者发生急性肺损伤的影响因素分析

Influencing factors of acute lung injury in patients with acute type-A aortic dissection

摘要:

目的 探讨急性A型主动脉夹层患者发生急性肺损伤（ALI）的影响因素。方法 选取2017年1月—2019年12月于邯郸市中心医院就诊的急性A型主动脉夹层患者347例作为研究对象，按是否合并ALI分为ALI组（氧合指数≤ 200 mmHg，115例）和NALI组（氧合指数>200 mmHg，232例）。比较两组患者一般临床资料、Th17细胞、凝血及纤溶系统指标的差异，分析急性A型主动脉夹层患者发生ALI的危险因素。结果 ALI组患者的年龄、胸腔积液比例、肠系膜上动脉受累比例、肾动脉双侧受累比例、白细胞计数、C反应蛋白水平高于NALI组（P <0.05）。ALI组患者的Th17细胞、组织因子（TF）、组织因子途径抑制物（TFPI）、D-二聚体、纤维蛋白原降解产物（FDP）、纤溶酶原激活物抑制剂（PAI-1）均高于NALI组（P <0.05），而活化部分凝血活酶时间（APTT）和凝血酶原时间（PT）均低于NALI组（P <0.05）。Pearson相关分析显示ALI组患者的TF（r =-0.808）、D-二聚体（r =-0.695）、PAI-1（r =-0.729）、Th17细胞（r =-0.805）与氧合指数均呈负相关（P <0.05）。Logistic回归分析显示高龄［R=1.849（95% CI：1.132，9.147）］、肠系膜上动脉受累［R=3.429（95% CI：1.264，11.138）］、胸腔积液［R=2.679（95% CI：1.627，10.149）］、Th17细胞比例升高［R=2.647（95% CI：1.167，8.267）］、TF升高［R=1.723（95% CI：1.117，8.445）］、D-二聚体升高［R=1.746（95% CI：1.366，10.546）］均是急性A型主动脉夹层患者并发ALI的危险因素（P <0.05）。结论 急性A型主动脉夹层合并ALI患者的Th17细胞、凝血及纤溶系统指标异常升高；Th17细胞比例增加、TF和D-二聚体升高、高龄、肠系膜上动脉受累及胸腔积液是急性A型主动脉夹层患者并发ALI的危险因素。

Abstract:

Objective To explore the influencing factors of acute lung injury (ALI) in patients with acute type-A aortic dissection (AAD).Methods A total of 347 patients with AAD who were followed up in Handan Central Hospital from January 2017 to December 2019 were selected as the study objects. According to whether ALI occurred, they were divided into ALI group (oxygenation index ≤ 200 mmHg, 115 cases) and NALI group (oxygenation index > 200 mmHg, 232 cases), the general clinical data, Th17 cells, coagulation, and fibrinolysis system indexes of the two groups were compared, and the risk factors of ALI in patients with AAD were analyzed.Results Age, proportion of pleural effusion, proportion of involvement of superior mesenteric artery, bilateral involvement of renal artery, white blood cell count and C-reactive protein in the ALI group were higher than those in the NALI group (P < 0.05). The levels of Th17 cells, tissue factor (TF), tissue factor pathway inhibitor (TFPI), D-dimer, fibrin degradation product (FDP), and plasminogen activator inhibitor (PAI-1) in ALI group were higher than those in NALI group (P < 0.05), while activation of partial thromboplastin time (APTT) and prothrombin time (PT) were lower than those of NALI group (P < 0.05). Pearson correlation analysis showed that TF (r = -0.808), D-dimer (r = -0.695), PAI-1 (r = -0.729), and Th17 cells (r = -0.805) in the ALI group were negatively correlated with the oxygenation index (P < 0.05). Logistic regression analysis showed that advanced age [R = 1.849, (95% CI: 1.132, 9.147)], involvement of superior enteric artery [R = 3.429 (95% CI: 1.264, 11.138), pleural effusion [R = 2.679 (95% CI: 1.627, 10.149)], increased proportion of Th17 cells [R = 2.647 (95% CI: 1.167, 8.267)], increased TF [R = 1.723 (95% CI: 1.117, 8.445)], and increased D-dimer [R = 1.746 (95% CI: 1.366, 10.546)] were all risk factors for complicated ALI in AAD patients (P < 0.05).Conclusion The Th17 cells, coagulation, and fibrinolytic system in patients with AAD combined with ALI are abnormal increase. The proportion of Th17 cells increased, increased TF and D-dimer, advanced age, involvement of superior mesenteric artery, and pleural effusion are the risk factors of complicated ALI in AAD patients.