中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2014年
22期
24-29
,共6页
张立%何亮%杜宇奎%买买提艾力·艾则孜%张总刚%唐和年
張立%何亮%杜宇奎%買買提艾力·艾則孜%張總剛%唐和年
장립%하량%두우규%매매제애력·애칙자%장총강%당화년
主动脉夹层%肝功能%Stanford A
主動脈夾層%肝功能%Stanford A
주동맥협층%간공능%Stanford A
Aortic dissection%Liver function%Stanford A
目的：探讨Stanford A型主动脉夹层术前肝功能状态并分析影响因素。方法选择2004年1月~2013年9月,新疆维吾尔自治区人民医院连续收治的157例Stanford A型主动脉夹层患者(夹层组),其中急性期患者91例,亚急性期患者41例,慢性期夹层患者25例。选取同期年龄和性别匹配的体检健康者95例为对照组。入选者采集空腹12 h以上静脉血,采用罗氏模块式全自动生化分析系统测定血清肝功能,指标包括胆碱酯酶(CHE)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、总蛋白(TP)、白蛋白(ALB)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(GGT)、谷氨酰转肽酶(ALP)。采用东芝Aquilion ONE 320排CT行全主动脉CTA,测定夹层原发破口,剥离范围。飞利浦5500型彩色多普勒心脏超声诊断仪行心彩超检查,评估主动脉瓣返流情况。结果 Stanford A型主动脉夹层组术前肝功能各指标与对照组比较,差异有统计学意义(P<0.05或P<0.01)[CHE：(9.31±3.02)KU/L比(8.28±1.78)KU/L；TBIL：(34.59±16.64)μmol/L比(13.22±6.59)μmol/L；DBIL：(7.07±3.53)μmol/L比(4.70±1.47)μmol/L；IBIL：(14.43±6.75)μmol/L比(6.93±3.39)μmol/L；TP：(65.16±8.33)g/L比(70.64±6.12)g/L；ALB：(38.63±6.40)g/L比(43.39±4.55)g/L；ALT：(0.04±0.02)U/L比(0.05±0.02)U/L；AST：(0.04±0.02)U/L比(0.06±0.02)U/L；GGT：(51.94±25.29)U/L比(35.56±16.24)U/L；ALP：(82.13±40.99)U/L比(71.25±24.21)U/L]。Stanford A型主动脉夹层急性期、亚急性期、慢性期之间部分肝功能指标存在差异,差异有统计学意义(P<0.05或P<0.01)。相关分析显示CHE与性别和夹层分型呈正相关(r=0.18,P=0.03；r=0.34,P=0.00)；TBIL与主动脉夹层分期和患者年龄呈负相关(r=-0.22,P=0.01；r=-0.24,P=0.00)；IBIL与主动脉夹层分期呈负相关,与夹层远端剥离水平呈正相关(r=-0.20,P=0.03；r=0.21,P=0.04)；ALB与主动脉夹层分期呈负相关(r=-0.33,P=0.00)；GGT与主动脉夹层分期呈正相关(r =0.19,P=0.02)；与患者年龄负呈相关(r =-0.18,P=0.03)；ALP与主动脉夹层分期和患者性别呈正相关(r=0.17,P=0.04；r=0.20,P=0.02)。结论Stanford A型主动脉夹层术前肝功能受损明显,受主动脉夹层分期影响,急性期夹层、亚急性期夹层肝功能损害明显；进入慢性期后肝功能各指标有所恢复。
目的：探討Stanford A型主動脈夾層術前肝功能狀態併分析影響因素。方法選擇2004年1月~2013年9月,新疆維吾爾自治區人民醫院連續收治的157例Stanford A型主動脈夾層患者(夾層組),其中急性期患者91例,亞急性期患者41例,慢性期夾層患者25例。選取同期年齡和性彆匹配的體檢健康者95例為對照組。入選者採集空腹12 h以上靜脈血,採用囉氏模塊式全自動生化分析繫統測定血清肝功能,指標包括膽堿酯酶(CHE)、總膽紅素(TBIL)、直接膽紅素(DBIL)、間接膽紅素(IBIL)、總蛋白(TP)、白蛋白(ALB)、丙氨痠氨基轉移酶(ALT)、天門鼕氨痠氨基轉移酶(AST)、堿性燐痠酶(GGT)、穀氨酰轉肽酶(ALP)。採用東芝Aquilion ONE 320排CT行全主動脈CTA,測定夾層原髮破口,剝離範圍。飛利浦5500型綵色多普勒心髒超聲診斷儀行心綵超檢查,評估主動脈瓣返流情況。結果 Stanford A型主動脈夾層組術前肝功能各指標與對照組比較,差異有統計學意義(P<0.05或P<0.01)[CHE：(9.31±3.02)KU/L比(8.28±1.78)KU/L；TBIL：(34.59±16.64)μmol/L比(13.22±6.59)μmol/L；DBIL：(7.07±3.53)μmol/L比(4.70±1.47)μmol/L；IBIL：(14.43±6.75)μmol/L比(6.93±3.39)μmol/L；TP：(65.16±8.33)g/L比(70.64±6.12)g/L；ALB：(38.63±6.40)g/L比(43.39±4.55)g/L；ALT：(0.04±0.02)U/L比(0.05±0.02)U/L；AST：(0.04±0.02)U/L比(0.06±0.02)U/L；GGT：(51.94±25.29)U/L比(35.56±16.24)U/L；ALP：(82.13±40.99)U/L比(71.25±24.21)U/L]。Stanford A型主動脈夾層急性期、亞急性期、慢性期之間部分肝功能指標存在差異,差異有統計學意義(P<0.05或P<0.01)。相關分析顯示CHE與性彆和夾層分型呈正相關(r=0.18,P=0.03；r=0.34,P=0.00)；TBIL與主動脈夾層分期和患者年齡呈負相關(r=-0.22,P=0.01；r=-0.24,P=0.00)；IBIL與主動脈夾層分期呈負相關,與夾層遠耑剝離水平呈正相關(r=-0.20,P=0.03；r=0.21,P=0.04)；ALB與主動脈夾層分期呈負相關(r=-0.33,P=0.00)；GGT與主動脈夾層分期呈正相關(r =0.19,P=0.02)；與患者年齡負呈相關(r =-0.18,P=0.03)；ALP與主動脈夾層分期和患者性彆呈正相關(r=0.17,P=0.04；r=0.20,P=0.02)。結論Stanford A型主動脈夾層術前肝功能受損明顯,受主動脈夾層分期影響,急性期夾層、亞急性期夾層肝功能損害明顯；進入慢性期後肝功能各指標有所恢複。
목적：탐토Stanford A형주동맥협층술전간공능상태병분석영향인소。방법선택2004년1월~2013년9월,신강유오이자치구인민의원련속수치적157례Stanford A형주동맥협층환자(협층조),기중급성기환자91례,아급성기환자41례,만성기협층환자25례。선취동기년령화성별필배적체검건강자95례위대조조。입선자채집공복12 h이상정맥혈,채용라씨모괴식전자동생화분석계통측정혈청간공능,지표포괄담감지매(CHE)、총담홍소(TBIL)、직접담홍소(DBIL)、간접담홍소(IBIL)、총단백(TP)、백단백(ALB)、병안산안기전이매(ALT)、천문동안산안기전이매(AST)、감성린산매(GGT)、곡안선전태매(ALP)。채용동지Aquilion ONE 320배CT행전주동맥CTA,측정협층원발파구,박리범위。비리포5500형채색다보륵심장초성진단의행심채초검사,평고주동맥판반류정황。결과 Stanford A형주동맥협층조술전간공능각지표여대조조비교,차이유통계학의의(P<0.05혹P<0.01)[CHE：(9.31±3.02)KU/L비(8.28±1.78)KU/L；TBIL：(34.59±16.64)μmol/L비(13.22±6.59)μmol/L；DBIL：(7.07±3.53)μmol/L비(4.70±1.47)μmol/L；IBIL：(14.43±6.75)μmol/L비(6.93±3.39)μmol/L；TP：(65.16±8.33)g/L비(70.64±6.12)g/L；ALB：(38.63±6.40)g/L비(43.39±4.55)g/L；ALT：(0.04±0.02)U/L비(0.05±0.02)U/L；AST：(0.04±0.02)U/L비(0.06±0.02)U/L；GGT：(51.94±25.29)U/L비(35.56±16.24)U/L；ALP：(82.13±40.99)U/L비(71.25±24.21)U/L]。Stanford A형주동맥협층급성기、아급성기、만성기지간부분간공능지표존재차이,차이유통계학의의(P<0.05혹P<0.01)。상관분석현시CHE여성별화협층분형정정상관(r=0.18,P=0.03；r=0.34,P=0.00)；TBIL여주동맥협층분기화환자년령정부상관(r=-0.22,P=0.01；r=-0.24,P=0.00)；IBIL여주동맥협층분기정부상관,여협층원단박리수평정정상관(r=-0.20,P=0.03；r=0.21,P=0.04)；ALB여주동맥협층분기정부상관(r=-0.33,P=0.00)；GGT여주동맥협층분기정정상관(r =0.19,P=0.02)；여환자년령부정상관(r =-0.18,P=0.03)；ALP여주동맥협층분기화환자성별정정상관(r=0.17,P=0.04；r=0.20,P=0.02)。결론Stanford A형주동맥협층술전간공능수손명현,수주동맥협층분기영향,급성기협층、아급성기협층간공능손해명현；진입만성기후간공능각지표유소회복。
Objective To investigate preoperative liver function and relative influencing factors in Stanford type A aor-tic dissection. Methods From January 2004 to September 2013, 157 consecutive patients with Stanford type A aortic dissection were admitted in the People's Hospital of Xinjiang Uygur Autonomous Region were selected as the aortic dissection group. Among the patiens, acute stage were 91 cases, subacute stage were 41 cases, chronic stage were 25 cases. At the same time, 95 healthy people with similar age and sex were taken as the control group. Fasting venous blood collected more than 12 h was collected, liver function indexes such as CHE, TBIL, DBIL, IBIL, TP, ALB, ALT, AST, GGT, ALP were measured by Roche modular automatic biochemical analysis system. Primary entry tear and ex-tent of aortic dissection was measured by Toshiba Aquilion ONE 320 slice CT. Degree of aortic valve insufficiency was measured by Philips Sonos 5500 Color Doppler ultrasonic diagnostic apparatus. Results The level of liver function indexes existed significant difference between the aortic dissection group and control group (P< 0.05 or P< 0.01) [CHE: (9.31±3.02) KU/L vs (8.28±1.78) KU/L; TBIL:(34.59±16.60)μmol/L vs (13.22±6.59)μmol/L;DBIL:(7.07±3.53)μmol/L vs (4.70±1.47);IBIL:(14.43±6.75) μmol/L vs (6.93±3.39)μmol/L;TP:(65.16±8.33) g/L vs (70.64±6.12) g/L; ALB:(38.63±6.40) g/L vs (43.39±4.55) g/L;ALT:(0.04±0.02) U/L vs (0.05±0.02) U/L; AST:(0.04±0.02) U/L vs (0.06±0.02) U/L; GGT:(51.94±25.29) U/L vs (35.56±16.24) U/L;ALP:(82.13±40.99)U/L vs (71.25±24.21) U/L]. Part liver function indexes existed difference between acute stage, suba-cute stage and chronic stage, the differences were statistically significant (P<0.05 or P<0.01). CHE positively corre-lated with patients sex and type of aortic dissection (r= 0.18, P=0.03; r= 0.34, P=0.00), TBIL negatively correlated with disease course of aortic dissection and patients ages (r=-0.22, P=0.01;r=-0.24, P=0.00), IBIL negatively cor-related with disease course of aortic dissection and positively with extent of aortic dissection (r=-0.20, P= 0.03; r =0.21, P=0.04), ALB negatively correlated with disease course of aortic dissection (r=-0.33, P=0.00), GGT positively correlated with disease course of aortic dissection and negatively with patients ages (r=0.19, P=0.02;r=-0.18, P=0.03), ALP positively correlated with disease course of aortic dissection and patients sex (r =0.17, P=0.04; r= 0.20, P=0.02). Conclusion It exists damaged liver function in preoperative Stanford type A aortic dissection, more seriously in acute stage group and subacute stage group. Liver function is improved significantly in chronic stage group.
