2022 年第 7 期 第 17 卷

西安地区急性Stanford A 型主动脉夹层患者的流行病学特征及术后发生急性肾损伤的影响因素

Epidemiological characteristics of patients with acute Stanford type A aortic dissection in Xi′an area and influencing factors of postoperative acute kidney injury

作者：李培薛万腾赵鹏

英文作者：Li Pei Xue Wanteng Zhao Peng

单位：空军军医大学第一附属医院急诊科，西安710032

英文单位：Department of Emergency the First Affiliated Hospital of Air Force Medical University Xi′an 710032 China

关键词：急性StanfordA型主动脉夹层；流行病学特征；急性肾损伤

英文关键词：AcuteStanfordtypeAaorticdissection;Epidemiologicalcharacteristics;Acutekidneyinjury

• 摘要：

• 目的 分析西安地区急性Stanford A 型主动脉夹层（ATAAD）患者的流行病学特征，探讨术后发生急性肾损伤（AKI）的影响因素。方法 选取2016年1月1日至2020年12月31日于西安地区15家医院确诊并最终于空军军医大学第一附属医院入院治疗的1 247例ATAAD患者作为研究对象。分析西安地区ATAAD的流行病学特征。选取空军军医大学第一附属医院的163例研究对象，根据术后是否发生AKI将其分为AKI组（71例）和非AKI组（92例）。通过多因素Logistic回归模型分析ATAAD患者术后发生AKI的危险因素，构建列线图模型，并对模型进行验证。结果 1 247例ATAAD患者中，男653例（52.4%）、女594例（47.6%），男性患者比例明显高于女性患者；50~59岁患者比例最高；冬季发病率最高［12—2月，35.0%（436/1 247）］（均P＜0.05）。多因素Logistic回归分析结果显示，高血压病、心脏压塞、体外循环时间、白细胞计数（WBC）、血肌酐是ATAAD患者术后并发AKI的独立危险因素（均P＜0.05）。将上述独立危险因素用于构建列线图模型，结果显示，高血压病、心脏压塞、体外循环时间≥200 min、WBC≥12×109/L、血肌酐≥80 μmol/L共计244.85分，预测ATAAD患者术后发生AKI的概率为65%。列线图模型一致性指数为0.837（95%置信区间：0.796~0.843），实际曲线与理想曲线具有较高的一致性。结论 西安地区ATAAD患者相对年轻，冬季为该病高发期，具有明显的人口学特征和季节性特征。ATAAD患者术后易发生AKI，且高血压病、心脏压塞、体外循环时间、WBC、血肌酐均为患者术后发生AKI的独立危险因素。

• Objective To analyze the epidemiological characteristics of patients with acute Stanford type A aortic dissection (ATAAD) in Xi′an area, and to investigate influencing factors of postoperative acute kidney injury (AKI). Methods Totally 1 247 patients with ATAAD diagnosed in 15 hospitals in Xi′an, and hospitalized in the First Affiliated Hospital of Air Force Medical University, from January 1, 2016 to December 31, 2020 were enrolled. The epidemiological characteristics of ATAAD in Xi′an was analyzed. There were 163 cases from the First Affiliated Hospital of Air Force Medical University were divided into AKI group (71 cases) and non-AKI group (92 cases) according to whether they had postoperative AKI. Multivariate Logistic regression model was used to analyze the risk factors of postoperative AKI in ATAAD patients. The nomogram model was constructed and verified. Results Among the 1 247 ATAAD patients, there were 653 cases (52.4%) of male and 594 cases (47.6%) of female, and the proportion of male was higher than that of female; the proportion of 50-59 years was the highest; the incidence of ATAAD was highest in winter ［from December to February, 35.0%(436/1 247)］(all P<0.05). Multivariate Logistic regression analysis showed that hypertension, pericardial tamponade, cardiopulmonary bypass time, white blood cell count (WBC) and serum creatinine were independent risk factors of postoperative AKI in ATAAD patients (all P<0.05). The above independent risk factors were used to construct the nomogram model, and it was showed that the total score of hypertension, pericardial tamponade, cardiopulmonary bypass time≥200 min, WBC≥12×109/L and serum creatinine≥80 μmol/L was 244.85, and the probability to predict postoperative AKI in ATAAD patients was 65%. The consistency index of nomogram model was 0.837(95% confidence interval: 0.796-0.843), and the actual curve had high consistency with the ideal curve. Conclusions Patients with ATAAD in Xi′an area are young, and winter is the period of high incidence of the disease, with obvious demographic and seasonal characteristics. AKI is prone to occur in patients with ATAAD after operation, and hypertension, pericardial tamponade, cardiopulmonary bypass time, WBC and serum creatinine are independent risk factors for postoperative AKI.