Stanford A 型主动脉夹层术前肝功能影响因素的多因素分析

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〈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〈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?

Multiple factor analysis of preoperative liver function in Stanford type A aortic dissection

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＆#39;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 〈 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 〈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 aorti