【摘要】：目的:通過(guò)對(duì)急性主動(dòng)脈夾層(AAD)并發(fā)急性肺損傷(ALI)的危險(xiǎn)因素分析,建立AAD并發(fā)ALI的預(yù)測(cè)評(píng)分表。方法:回顧性分析新疆醫(yī)科大學(xué)第一附屬醫(yī)院心臟中心2014年1月至2015年12月連續(xù)收治的143例AAD患者的臨床資料,按是否發(fā)生ALI分為ALI組和非ALI組,對(duì)可能的危險(xiǎn)因素進(jìn)行單因素分析,將有統(tǒng)計(jì)學(xué)差異的相關(guān)因素,通過(guò)繪制受試者工作特征曲線(ROC曲線),分析其對(duì)ALI發(fā)生的最佳臨界值和預(yù)測(cè)價(jià)值,并根據(jù)最佳臨界值將相關(guān)的連續(xù)性變量轉(zhuǎn)化為二分類(lèi)變量,進(jìn)行多因素Logistic回歸分析,根據(jù)各個(gè)危險(xiǎn)因素的OR值大小,對(duì)獨(dú)立危險(xiǎn)因素賦分,建立預(yù)測(cè)評(píng)分表。結(jié)果:(1)AAD并發(fā)ALI的發(fā)生率約為44.76%。(2)ALI組的BMI、入院時(shí)WBC及入院時(shí)CRP較非ALI組均偏高,在兩組間差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。ALI組與非ALI組相比,ALI組患者入院時(shí)易伴有胸腔積液,在兩組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)通過(guò)繪制ROC曲線,BMI預(yù)測(cè)AAD并發(fā)ALI的最佳臨界值為25.65kg/m2(敏感度為87.5%,特異度為40.5%),WBC預(yù)測(cè)AAD并發(fā)ALI的最佳臨界值為15.00×109/L(敏感度為59.4%,特異度為81.0%),CRP預(yù)測(cè)AAD并發(fā)ALI的最佳臨界值為15.81mg/L(敏感度為51.6%,特異度為75.6%)。入院時(shí)伴有胸腔積液預(yù)測(cè)AAD并發(fā)ALI的敏感度為57.8%,特異度為65.8%。(4)兩組患者經(jīng)多因素Logistic回歸分析發(fā)現(xiàn),WBC≥15.00×109/L(OR=7.143,95%CI 2.972-17.169)、CRP≥15.81mg/L(OR=2.696,95%CI 1.156-6.284)、BMI≥25.65 kg/m2(OR=5.892,95%CI 2.117-16.396)及胸腔積液(OR=4.365,95%CI 1.849-10.300)是AAD并發(fā)ALI的獨(dú)立危險(xiǎn)因素。(5)AAD患者按照獨(dú)立危險(xiǎn)因素在預(yù)測(cè)評(píng)分表中分值高低可分為三組:低危組(分值0-3)、中危組(分值4-6)和高危組(分值7-9),低危組ALI發(fā)生率約為12.5%,中危組ALI發(fā)生率約為53.7%,高危組ALI發(fā)生率約為84.8%。結(jié)論:通過(guò)對(duì)AAD并發(fā)ALI的危險(xiǎn)因素分析,BMI≥25.65kg/m2、入院時(shí)WBC≥15.00×109/L、入院時(shí)CRP≥15.81mg/L及入院時(shí)伴有胸腔積液是AAD并發(fā)ALI的獨(dú)立危險(xiǎn)因素。AAD并發(fā)ALI的預(yù)測(cè)評(píng)分表可預(yù)見(jiàn)性地評(píng)估AAD患者發(fā)生ALI的風(fēng)險(xiǎn),有助于對(duì)AAD患者進(jìn)行分層管理。
[Abstract]:Objective: to study the risk factors of acute aortic dissection (AAD) complicated with acute lung injury (ALI) and to establish a predictive scale for AAD complicated with ALI. Methods: the clinical data of 143 consecutive patients with AAD admitted to the Cardiac Center of the first affiliated Hospital of Xinjiang Medical University from January 2014 to December 2015 were retrospectively analyzed. According to the occurrence of ALI, they were divided into ALI group and non-ALI group. By univariate analysis of possible risk factors and correlation factors with statistical differences, the optimal critical value and predictive value of ALI were analyzed by drawing the operating characteristic curve (ROC curve) of the subjects. According to the optimal critical value, the related continuous variables are transformed into two classification variables, and the multivariate Logistic regression analysis is carried out. According to the OR value of each risk factor, the independent risk factors are assigned a score, and the prediction score table is established. Results: (1) the incidence of AAD complicated with ALI was about 44.76. (2) the WBC and CRP of BMI, in ALI group were higher than those in non-ALI group at admission, and there was significant difference between the two groups (P0.05 between). ALI group and non-ALI group). The patients in ALI group were more likely to be accompanied with pleural effusion on admission. The difference between the two groups was statistically significant (P0.05). (3). By drawing the ROC curve, the best critical value of BMI for predicting AAD complicated with ALI was 25.65kg/m2 (sensitivity was 87.5%). The best critical value for predicting AAD complicated with ALI with 40.5%), WBC was 15.00 脳 10 ~ 9 / L (sensitivity was 59.4%, specificity was 81.0%). The best critical value for AAD complicated with ALI by CRP was 15.81mg/L (sensitivity was 51.6%, specificity was 75.6%). At admission, the sensitivity and specificity of AAD complicated with ALI were 57.8 and 65.8 respectively. (4) by multivariate Logistic regression analysis, WBC 鈮，

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