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目的探讨Stanford A型主动脉夹层术前心肌酶谱水平并分析影响因素。方法收集2004年1月至2013月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,男134例,女23例,年龄20~78(50±12)岁。急性期患者91例,亚急性期患者41例,慢性期夹层患者25例,并选取年龄和性别匹配的体检健康者95例为对照组。对所有研究对象采集空腹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,行全主动脉CT血管造影,测定夹层原发破口,剥离范围。行心脏彩超检查,评估主动脉瓣反流情况。结果 Stanford A型主动脉夹层组术前心肌酶谱[肌酸激酶(CK)、乳酸脱氢酶(LDH)、α-羟基丁酸脱氢酶(α-HBDH)]显著高于与对照组(t=3.844、4.030、3.427,P均<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、CK-MB存在差异(F=7.701、5.355,P=0.001、0.006),而亚急性期、慢性期两组心肌酶谱CK、CK-MB差异均无统计学意义(P均>0.05)。相关分析显示,CK与临床分期以及性别呈负相关(r=-0.307、-0.206,P=0.000、0.014),CK-MB与夹层分期呈负相关(r=-0.251、P=0.003),LDH与患者性别、年龄呈负相关(r=-0.195、-0.198,P=0.021、0.019),HBDH不受上述因素影响。结论 Stanford A型主动脉夹层术前心肌酶谱明显升高,而心肌与骨骼肌损伤程度可能与临床分期相关。
Objective To investigate the level of myocardial enzymes before Stanford type A aortic dissection and analyze the influencing factors. Methods A total of 157 consecutive patients with Stanford type A aortic dissection were enrolled in the People ’s Hospital of Xinjiang Uyghur Autonomous Region from January 2004 to September 1999. There were 134 males and 23 females, aged 20-78 years (50 ± 12 years). 91 cases of acute phase, 41 cases of subacute phase, 25 cases of chronic phase disseminated, and select the age and sex matched 95 cases of healthy subjects as the control group. All the subjects were collected fasting for more than 12 h venous blood, using Roche model automatic biochemical analysis of serum myocardial enzymes, line of aorta CT angiography, determination of the primary dissection, dissection range. Cardiac color Doppler ultrasound assessment of aortic regurgitation. Results Preoperative myocardial enzymes (CK, LDH and α-HBDH) in Stanford type A aortic dissection group were significantly higher than those in control group t = 3.844,4.030,3.427, P <0.05). CK and CK-MB in acute phase group and those in subacute phase and chronic phase were only difference (F = 7.701,5.355, P = 0.001,0.006), while in CK, , CK-MB differences were not statistically significant (P all> 0.05). Correlation analysis showed that CK was negatively correlated with clinical stage and sex (r = -0.307, -0.206, P = 0.000,0.014), CK-MB was negatively correlated with stage (r = -0.251, P = 0.003) Negatively correlated with patient’s sex and age (r = -0.195, -0.198, P = 0.021,0.019), HBDH was not affected by the above factors. Conclusions The myocardial enzyme spectrum of Stanford type A aortic dissection is obviously increased, while the myocardial and skeletal muscle damage may be correlated with the clinical stage.