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2019 年第 1 期 第 14 卷

中性粒细胞/淋巴细胞比值对急性Stanford_B型主动脉夹层患者胸主动脉腔内修复术后疗效的预测价值

Prognostic value of neutrophil-to-lymphocyte ratio in acute Stanford type B aortic dissection patients treated with thoracic endovascular aortic repair

作者:姜海军赵博霍静杨植徐繁李潇尹晶杜建青

英文作者:

单位:067000承德医学院附属医院血管普外科(姜海军、杨植、尹晶、杜建青),输血科(赵博),全科医学科(霍静),肿瘤内科(徐繁),放射科(李潇)

英文单位:

关键词:急性StanfordB型主动脉夹层;胸主动脉腔内修复术;中性粒细胞与淋巴细胞比值

英文关键词:

  • 摘要:
  • 【摘要】目的    探讨中性粒细胞/淋巴细胞比值(NLR)对急性Stanford B型主动脉夹层患者胸主动脉腔内修复术(TEVAR)术后疗效的预测价值。方法    收集2016年1—12月在承德医学院附属医院血管普外科就诊的120例急性Stanford B型主动脉夹层患者的临床资料,均在确诊后的1~3 d内行TEVAR。根据患者入院时NLR分为低NLR组(NLR<5.0,62例)和高NLR组(NLR≥5.0,58例)。分析患者的一般资料、实验室检测指标、院内死亡率以及随访期间不良事件发生情况,采用单因素和多因素COX模型分析患者院内死亡率的风险因素。结果    高NLR组收缩压、舒张压、心率高于低NLR组,血小板计数低于低NLR组(均P<0.001)。高NLR组院内死亡率明显高于低NLR组[17.2%(10/58)比1.6%(1/62)](P=0.003)。高NLR组昏迷神经症状、低血压、急性肾功能受损、肢体缺血发生率高于低NLR组[20.7%(12/58)比3.2%(2/62)、20.7%(12/58)比1.6%(1/62)、24.1%(14/58)比4.8%(3/62)、20.7%(12/58)比1.6%(1/62)](均P<0.01)。单因素COX分析结果显示,年龄、动脉粥样硬化史、血小板计数、血清白蛋白含量与院内死亡率有关(均P<0.01)。多因素COX分析结果显示,NLR≥5.0(风险比=3.127,95%置信区间:1.192~10.892,P=0.018)、血小板计数(风险比=0.978,95%置信区间:0.945~0.996,P=0.012)、血清白蛋白含量(风险比=0.882,95%置信区间:0.809~0.977,P=0.005)均为Stanford B型主动脉夹层患者TEVAR术后院内死亡的独立预测因素(均P<0.05)。结论    NLR可以作为Stanford B型主动脉夹层患者TEVAR术后死亡风险的预测因素。

  • 【Abstract】Objective    To explore the value of neutrophil-to-lymphocyte ratio in prognostic prediction of acute Stanford type B aortic dissection patients treated with thoracic endovascular aortic repair(TEVAR). Methods    Clinical data of 120 acute Stanford type B aortic dissection patients admitted in Affiliated Hospital of Chengde Medical University from January to December 2016 were retrospectively analyzed. All patients had TEVAR in 1-3 d. According to NLR at admission, they were divided into low NLR group(NLR<5.0, n=62) and high NLR group(NLR≥5.0, n=58). General information, laboratory indicators, in-hospital mortality and adverse events were analyzed. Risk factors of in-hospital mortality were analyzed by COX model. Results    Systolic blood pressure, diastolic blood pressure and heart rate in the high NLR group were higher and platelet count was lower than those in the low NLR group(P<0.001). In-hospital mortality rate in the high NLR group was higher than that in the low NLR group[17.2%(10/58) vs 1.6%(1/62)](P=0.003). Incidences of coma neurological symptoms, hypotension, acute renal impairment and limb ischemia in the high NLR group were higher than those in the low NLR group[20.7%(12/58) vs 3.2%(2/62), 20.7%(12/58) vs 1.6%(1/62), 24.1%(14/58) vs 4.8%(3/62), 20.7%(12/58) vs 1.6%(1/62)](P<0.01). Single factor COX analysis showed that age, atherosclerosis history, platelet count and serum albumin were related to in-hospital mortality(all P<0.01). Multi-factor COX analysis showed that NLR≥5.0(hazard ratio=3.127, 95% confidence interval: 1.192-10.892, P=0.018), platelet count(hazard ratio=0.978, 95% confidence interval: 0.945-0.996, P=0.012) and serum albumin(hazard ratio=0.882, 95% confidence interval: 0.809-0.977, P=0.005) were independent predictors of in-hospital mortality. Conclusion    NLR can be a prognostic predictor of mortality risk in acute Stanford type B aortic dissection treated with TEVAR.

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