CAJ | 학술논문

目的：探讨A型急性主动脉夹层患者入院时血小板计数与住院死亡率的相关性。方法：连续入选2012-02至2013-05就诊于我院并经计算机断层扫描（CT）证实的A型急性主动脉夹层患者183例，男性126例（68.9%）。分组：①根据患者住院期间是否存活分为存活组（n=157）,死亡组（n=26）；②根据血小板计数五分位值将患者分五组，即血小板计数第1分位（≤119×109/L）组（Q1组，n=36），血小板计数第2分位（120~149×109/L）组（Q2组，n=37），血小板计数第3分位（150~173×109/L）组（Q3组，n=36），血小板计数第4分位（174~228×109/L）组（Q4组，n=37），血小板计数第5分位（>228×109/L）组（Q5组，n=37）；③按入院时血小板计数分为≤119×109/L组（n=36）和>119×109/L组（n=147），再根据是否接受手术治疗将其分为≤119×109/L手术者（n=18）、≤119×109/L非手术者（n=18）和>119×109/L手术者（n=96）、>119×109/L非手术者（n=51）。采集患者入院时的基线资料及静脉血标本，检测血小板计数、白细胞、D-二聚体等值。主要终点事件为住院死亡率。结果：183例A型急性主动脉夹层患者总住院死亡率为14.3%。死亡组与存活组比较，血小板计数显著减少、血压较低、D-二聚体水平较高； Q1组患者死亡率（38.9%）显著高于Q2、Q3、Q4和Q5四组（10.8%、11.1%、8.1%和2.7%），差异均有统计学意义（P<0.001）。Q5组较Q1组死亡风险增加（HR=11.2，95%CI 2.13~123.3，P=0.007），在调整了年龄、性别等影响预后的因素后，血小板计数≤119×109/L无论在手术治疗进入Cox模型前（HR3.90，95%CI 1.67~9.09， P=0.002）还是进入模型后（HR2.67，95%CI 1.15~6.19，P=0.023）均增加住院死亡风险。结论：A型急性主动脉夹层患者入院时血小板计数≤119×109/L住院死亡率风险明显增加。即使接受手术治疗，血小板计数值较低的患者仍与住院死亡风险相关。目的：探討A型急性主動脈夾層患者入院時血小闆計數與住院死亡率的相關性。方法：連續入選2012-02至2013-05就診于我院併經計算機斷層掃描（CT）證實的A型急性主動脈夾層患者183例，男性126例（68.9%）。分組：①根據患者住院期間是否存活分為存活組（n=157）,死亡組（n=26）；②根據血小闆計數五分位值將患者分五組，即血小闆計數第1分位（≤119×109/L）組（Q1組，n=36），血小闆計數第2分位（120~149×109/L）組（Q2組，n=37），血小闆計數第3分位（150~173×109/L）組（Q3組，n=36），血小闆計數第4分位（174~228×109/L）組（Q4組，n=37），血小闆計數第5分位（>228×109/L）組（Q5組，n=37）；③按入院時血小闆計數分為≤119×109/L組（n=36）和>119×109/L組（n=147），再根據是否接受手術治療將其分為≤119×109/L手術者（n=18）、≤119×109/L非手術者（n=18）和>119×109/L手術者（n=96）、>119×109/L非手術者（n=51）。採集患者入院時的基線資料及靜脈血標本，檢測血小闆計數、白細胞、D-二聚體等值。主要終點事件為住院死亡率。結果：183例A型急性主動脈夾層患者總住院死亡率為14.3%。死亡組與存活組比較，血小闆計數顯著減少、血壓較低、D-二聚體水平較高； Q1組患者死亡率（38.9%）顯著高于Q2、Q3、Q4和Q5四組（10.8%、11.1%、8.1%和2.7%），差異均有統計學意義（P<0.001）。Q5組較Q1組死亡風險增加（HR=11.2，95%CI 2.13~123.3，P=0.007），在調整瞭年齡、性彆等影響預後的因素後，血小闆計數≤119×109/L無論在手術治療進入Cox模型前（HR3.90，95%CI 1.67~9.09， P=0.002）還是進入模型後（HR2.67，95%CI 1.15~6.19，P=0.023）均增加住院死亡風險。結論：A型急性主動脈夾層患者入院時血小闆計數≤119×109/L住院死亡率風險明顯增加。即使接受手術治療，血小闆計數值較低的患者仍與住院死亡風險相關。
목적：탐토A형급성주동맥협층환자입원시혈소판계수여주원사망솔적상관성。방법：련속입선2012-02지2013-05취진우아원병경계산궤단층소묘（CT）증실적A형급성주동맥협층환자183례，남성126례（68.9%）。분조：①근거환자주원기간시부존활분위존활조（n=157）,사망조（n=26）；②근거혈소판계수오분위치장환자분오조，즉혈소판계수제1분위（≤119×109/L）조（Q1조，n=36），혈소판계수제2분위（120~149×109/L）조（Q2조，n=37），혈소판계수제3분위（150~173×109/L）조（Q3조，n=36），혈소판계수제4분위（174~228×109/L）조（Q4조，n=37），혈소판계수제5분위（>228×109/L）조（Q5조，n=37）；③안입원시혈소판계수분위≤119×109/L조（n=36）화>119×109/L조（n=147），재근거시부접수수술치료장기분위≤119×109/L수술자（n=18）、≤119×109/L비수술자（n=18）화>119×109/L수술자（n=96）、>119×109/L비수술자（n=51）。채집환자입원시적기선자료급정맥혈표본，검측혈소판계수、백세포、D-이취체등치。주요종점사건위주원사망솔。결과：183례A형급성주동맥협층환자총주원사망솔위14.3%。사망조여존활조비교，혈소판계수현저감소、혈압교저、D-이취체수평교고； Q1조환자사망솔（38.9%）현저고우Q2、Q3、Q4화Q5사조（10.8%、11.1%、8.1%화2.7%），차이균유통계학의의（P<0.001）。Q5조교Q1조사망풍험증가（HR=11.2，95%CI 2.13~123.3，P=0.007），재조정료년령、성별등영향예후적인소후，혈소판계수≤119×109/L무론재수술치료진입Cox모형전（HR3.90，95%CI 1.67~9.09， P=0.002）환시진입모형후（HR2.67，95%CI 1.15~6.19，P=0.023）균증가주원사망풍험。결론：A형급성주동맥협층환자입원시혈소판계수≤119×109/L주원사망솔풍험명현증가。즉사접수수술치료，혈소판계수치교저적환자잉여주원사망풍험상관。
Objective: To explore the relationship between platelet counts at admission and in-hospital mortality in patients with type A acute aortic dissection (AAD). Methods: We investigated 183 consecutive patients with CT conifrmed diagnosis of type A AAD treated in our hospital from 2012-02 to 2013-05. There were 126 (68.9%) male and the patients were divided into 3 sets of groups.①In-hospital surviving group,n=157 and In-hospital death group,n=26.②According to platelet counts, the patients were divided into 5 groups: Q1 group, platelet counts ≤ 119×109/L,n=36, Q2 group, platelet (120-149) ×109/L,n=37, Q3 group, platelet (150-173)×109/L, n=36, Q4 group, platelet (174-228)×109/L,n=37, Q5 group, platelet >228×109/L,n=37.③At admission, platelet ≤ 119×109/L,n=36 and platelet >119×109/L,n=147. In addition, the patients were further divided into another 4 groups based on operative condition: platelet ≤ 119×109/L with operation,n=18, without operation,n=18; platelet > 119×109/L with operation,n=96, without operation,n=51. The basic information at admission including platelet counts, WBC and D-dimer were studied in all groups, the primary endpoint was in-hospital mortality. Results: The overall in-hospital mortality was 14.3%. Compared with In-hospital surviving group, the In-hospital mortality group had decreased platelet counts, lower blood pressure and higher level of D-dimer. The mortality in Q1 group (38.9%) was higher than those in Q2, Q3, Q4 and Q5 groups (10.8%, 11.1%, 8.1% and 2.7%), allP<0.001. The risk of death in Q5 group was higher than Q1 group (HR=11.2, 95% CI 2.13-123.3,P=0.007). With adjusted age, gender and other relevant factors, when platelet counts ≤ 119×109/L, the risk of in-hospital mortality with Cox multivariate model I analysis was (HR3.90, 95% CI 1.67-9.09,P=0.002), with Cox model II was (HR=2.67, 95% CI 1.15 -6.19,P=0.023). Conclusion: AAD patients with admission platelet counts ≤ 119×109/L had the high risk of in-hospital death, even with operation, lower platelet counts was still related to in-hospital death.