Stanford B型主动脉夹层术前心肌酶谱影响因素的多因素分析

目的 探讨Stanford B型主动脉夹层术前心肌酶谱状态并分析影响因素.方法 2004年1月-2013月9月,新疆维吾尔自治区人民医院共收治151例Stanford B型主动脉夹层患者,男性118例,女性33例,年龄31 ～76岁,平均（51.51±10.90）岁.将其作为选取同期年龄和性别匹配的体检健康人群为对照组.入院患者采集空腹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心肌酶谱,指标包括肌酸激酶（CK）、肌酸激酶同工酶（CKMB）、乳酸脱氢酶（LDH）、α-羟基丁酸脱氢酶（HBDH）.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,评估主动脉瓣反流情况.结果 Stanford B型主动脉夹层组术前心肌酶谱相关指标LDH、HBDH显著高于对照组（P＜0.01）.将Stanford B型主动脉夹层患者进行分期后发现急性期组夹层心肌酶谱各指标与对照组相比除CKMB均存在差异（P＜0.05）.急性期组与亚急性期以及慢性期心肌酶谱相关指标仅CK存在差异（F=18.72,P=0.000）.亚急性期,慢性期两组心肌酶谱各指标未见明显差异,两组心肌酶谱LDH、HBDH与对照组相比存在差异（P＜0.01）.相关分析显示,CK与夹层分期以及患性别呈负相关（r=-0.446;P =0.000）;（r=-0.303;P=0.000）].CKMB与性别呈负相关（r=-0.203;P=0.020）].LDH与患者性别负相关（r=-0.171;P=0.049）],与心脏左室舒张期末径,收缩期末径呈正相关（r =0.202;P=0.022）;（r=0.271;P =0.002）].HBDH与心脏左室舒张期末径,收缩期末径呈正相关（r =0.385;P=0.002）;（r=0.515;P=0.000）],与主动脉瓣膜反流程度呈负相关（r=-0.528;P=0.006）].结论Stanford B型主动脉夹层术前心肌酶谱明显升高,主要表现为骨骼肌损伤.受主动脉夹层分期影响,急性期夹层下肢骨骼肌损伤明显,度过急性期后下肢骨骼肌损伤持续存在.

Multiple factor analysis of preoperative myocardial enzymes in stanford type B aortic dissection

Objective To investigate preoperative myocardial enzymes and realative influencing factors in Stanford B type aortic dissection.Methods From Jan.2004 to Sep.2013,151 consecutive patients with Stanford type B aortic dissection were admitted to hospital,aged from 31 to 76 average：（51.51 ± 10.90）year sold.Ninty-five healthy people with similar age and sex were taken as the control group.Fasting venous blood collected more than 12h was collected,myocardial enzymes indexes such as CK,CKMB,LDH,HBDH were measured by Roche modular automatic biochemical analysis system.Primary entry tear and extent 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 Compared with control group,the level of myocardial enzymes （LDH,HBDH） of aortic dissection group increased significantly（P ＜ 0.01）.part myocardial enzymes indexes（CK,LDH,HBDH） of acute stage group existed difference（P ＜ 0.05）.Myocardial enzymes indexes only CK existed difference between acute stage group and subacute stage group and chronic stage group（F =18.72,P =0.000）,no difference between subacute stage group and chronic stage group.LDH,HBDH of each sub group of aortic dissection group were higher than that of control group,P ＜ 0.01.Trough correlation analysis,CK negatively correlated with disease course of aortic dissection and patients sex （r =-0.446 ; P =0.000） ; （r =-0.303 ; P =0.000）],CKMB negatively correlated patients sex （r=-0.203;P=0.020）],LDH negatively correlated with patients sex （r =-0.171 ;P =0.049）],positively with left ventricular end-diastolic diameter and left ventricular end-systolic diameter （r =0.202 ; P =0.022） ; （r =0.271 ; P =0.002）].HBDH positively correlated with left ventricular enddiastolic diameter and left ventricular end-systolic diameter （r =0.385 ;P =0.002） ; （r =0.515 ; P =0.000）],negatively with degree of aortic insufficiency