摘要
目的 构建对急性主动脉综合征(AAS)诊断具有较高预测价值的AAS风险分层评分(AAS-RSS)。方法 回顾性收集2019年8月至2022年7月在济宁医学院附属医院急诊科就诊怀疑AAS患者共630例,根据AAS诊断标准将患者分为AAS组和非AAS组,其中AAS组346例,非AAS组284例。采用二分类logistic回归分析法分析AAS的独立危险因素,构建AAS-RSS,绘制ROC曲线对AAS-RSS进行评价。结果 AAS组男性、高血压病、突发胸背部痛、撕裂样或刀割样疼痛、疼痛评分≥5分、持续无缓解、大汗、呼吸困难、呕吐、动脉搏动消失或无脉、四肢血压差异明显、新发主动脉瓣杂音、低血压或休克、D-二聚体、C反应蛋白,合并心包填塞、肠功能障碍、急性肾损伤发生率高于非AAS组,差异有统计学意义(P<0.05)。AAS组深吸气或咳嗽诱发、针刺样疼痛、心悸、合并急性心肌梗死发生率低于非AAS组,差异有统计学意义(P<0.05)。logistic回归分析结果显示,男性、突发胸背部痛、撕裂样或刀割样疼痛、心悸、动脉搏动消失或无脉、D-二聚体、C反应蛋白、合并急性心肌梗死是AAS发生的影响因素(P<0.05)。根据logistic回归分析β值大小及结合ADD-RS(主动脉夹层检测风险评分),共有23个变量被有效整合成AAS-RSS。AAS-RSS分值高低与AAS的发生呈正相关(r=0.72,P<0.05)。AAS-RSS、ADD-RS预测发生AAS的曲线下面积分别为0.919(0.898~0.941)、0.734(0.694~0.773)。AAS-RSS约登指数最大值为0.699,截断值为8.5分,AAS-RSS评分9分为区分高危AAS和低危AAS的界值。AAS-RSS识别高危AAS的灵敏度、特异度分别为89.3%、80.6%;ADD-RS识别高危AAS的灵敏度、特异度分别为85.0%、52.5%。结论 AAS-RSS对AAS风险分层具有较高预测价值。
Objective To construct the acute aortic syndrome risk stratification score(AAS-RSS) with high predictive value for the diagnosis of acute aortic syndrome(AAS).Methods A total of 630 patients with suspected AAS who visited the Department of Emergency of the Affiliated Hospital of Jining Medical University from August 2019 to July 2022 were retrospectively collected.According to the diagnostic criteria of AAS,the patients were divided into AAS group and non-AAS group,of which 346 were in AAS group and 284 were in non-AAS group.Binary logistic regression analysis was used to analyze the independent risk factors of AAS,construct AAS-RSS,and draw ROC curve to evaluate AAS-RSS.Results In the AAS group,men,hypertension,sudden chest and back pain,lacerating or cutting pain,pain score ≥5 points,persistent no relief,sweating,dyspnea,vomiting,disappearance of arterial pulsation or no pulse,significant difference in blood pressure of limbs,new aortic murmur,hypotension or shock,D-dimer,C reactive protein,and so on,the incidence of pericardial tamponade,intestinal dysfunction,and acute kidney injury were higher than those of non-AAS group,and the differences were statistically significant(P<0.05).The incidence of deep inspiratory or cough induced,needle-like pain,palpitation,and acute myocardial infarction in AAS group were lower than those in non-AAS group,and the differences were statistically significant(P <0.05).Logistic regression analysis results showed that male,sudden chest and back pain,laceration or cutting pain,palpitation,disappear an ce of arterial pulsation or no pulse,D-dimer,C reactive protein,and complicated acute myocardial infarction were the influencing factors for the occurrence of AAS(P<0.05).According to logistic regression analysis of β-value size combined with ADD-RS(aortic dissection detection risk score),a total of 23variables were effectively integrated into AAS-RSS.AAS-RSS score was positively correlated with the occurrence of AAS(r=0.72,P <0.05).The areas under the curve of AAS-RSS and ADD-RS
作者
孟凡亮
付凤霞
徐鑫
王新艳
李勇
师猛
肖子亚
MENG Fanliang;FU Fengxia;XU Xin;WANG Xinyan;LI Yong;SHI Meng;XIAO Ziya(Department of Emergency,the Affiliated Hospital of Jining Medical University,Shandong Province,Jining 272029,China)
出处
《中国医药导报》
CAS
2024年第6期15-20,共6页
China Medical Herald
基金
山东省济宁市重点研发计划项目(2022YXNS045)
山东省医药卫生科技发展计划项目(202010000964)。
