术前系统性炎症与腹腔大动脉动脉瘤患者的存活率之间的关系
Nicholas A Bradley1, Amy Walter2, Alasdair Wilson3
1Clinical Research Fellow, University of Glasgow, Glasgow, Scotland, UK.
Annals of vascular surgery
|October 12, 2024
概括
在手术前和手术后,系统性炎症标志物与接受腹腔大动脉瘤 (AAA) 修复的患者的生存率较差有关. 手术后C反应蛋白 (CRP) 的升高是增加死亡风险的关键指标.
科学领域:
- 血管外科 血管外科
- 炎症生物学 炎症生物学
- 临床结果研究研究
背景情况:
- 系统性炎症标志物与腹腔大动脉动脉瘤 (AAA) 修复后的较差结果有关.
- 在AAA患者中术后炎症的预后意义尚未得到充分确立.
- 这项研究调查了AAA修复患者的术后炎症和死亡率之间的关联.
研究的目的:
- 评估手术前和手术后炎症标志物对内血管动脉瘤修复 (EVAR) 和下AAA的开放手术修复 (OSR) 后死亡率的影响.
- 确定特定的炎症标志物,预测AAA患者的短期和长期生存.
主要方法:
- 在三个中心连续接受紧急或选择性AAA修复的患者的回顾性分析.
- 使用修改的格拉斯哥预后分数评估手术前系统性炎症.
- 评估3日术后C反应蛋白 (CRP) 水平 (>300 mg/L vs. ≤300 mg/L) 作为一个关键的共同变量.
- 主要结局:紧急病例的30天死亡率和可选病例的12个月死亡率.
主要成果:
- 在紧急队列中,手术前修改的格拉斯哥预后得分2独立预测了30天死亡率 (OR:2.11).
- 在选择性队列中,年龄≥75 (OR:5.15) 和第3天手术后CRP>300 mg/L (OR:15.68) 独立预测了12个月死亡率.
- 较高的CRP水平在第3天与选择性队列的存活率降低 (112个月与67个月) 有显著的关联.
结论:
- 手术前和手术后的全身炎症标志物都独立地与AAA修复后的生存率低下有关.
- 术后CRP升高的第三天是紧急和选择性AAA修复中死亡率的重要预测因素.
- 对AAA患者的外科手术期间炎症反应进行进一步的研究是有必要的,以确定潜在的干预目标.
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