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在急性I型大动脉剖析中残留炎症轨迹的预后影响:双中心前性队列研究
Hong Liu1, Yi-Fei Diao1, Yong Feng Shao1
1Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing.
International journal of surgery (London, England)
|March 6, 2024
概括
在急性DeBakey I型大动脉剖析 (AAD) 中,外周血小板-白细胞比率 (PWR) 轨迹定义不佳. 确定了三个不同的PWR集群,其中一个集群表明死亡风险较高,有助于个性化AAD治疗.
科学领域:
- 心血管外科心血管外科
- 炎症生物标志物 炎症生物标志物
- 大动脉剖析研究研究
背景情况:
- 周围血小板-白细胞比率 (PWR) 整合了炎症和凝血病途径,作为急性DeBakey I型大动脉剖析 (AAD) 管理的关键措施.
- 然而,在AAD患者中,PWR的纵向模式 (轨迹) 仍然不充分理解.
研究的目的:
- 为了确定PWR在患者的独特轨迹进行紧急全门置换与冷大象干植入用于AAD.
- 确定这些PWR轨迹对患者结果的预后意义.
- 开发一种结合PWR轨迹的死亡率预测模型.
主要方法:
- 分析了两组AAD患者 (2020-2022),他们接受了冷大象植入的紧急全置换.
- 周围血小板-白细胞比率 (PWR) 数据在基线和手术后连续五天收集.
- 隐性类混合建模 (LCMM) 用于确定PWR轨迹模式,Cox回归确定了独立的风险因素. 开发了一个名图,包含PWR轨迹.
主要成果:
- 在246名AAD患者中确定了三种不同的PWR轨迹 (α,β和γ集群).
- 与α相比, γ在26个月的中位随访期间与较高的死亡风险有显著的关联.
- 开发和验证了包括年龄,血红蛋白,估计的膜过率和心肺时间在内的炎症名录,证明了足够的预测歧视 (AUC 0.765).
结论:
- 根据PWR轨迹确定了三个不同的集群,与AAD患者的短期结果相关.
- 通过PWR轨迹对残留炎症的纵向分析为AAD中个性化治疗策略提供了洞察力.
- 开发的诺莫格拉姆有助于预测AAD患者的手术死亡率.
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