术前血清碱性磷酸酶水平对胸主动脉腔内修复术后疗效的预测价值

The Predictive Value of Preoperative Serum Alkaline Phosphatase Level for Efficacy after Thoracic Endovascular Aortic Repair

摘要: 目的：探讨术前血清碱性磷酸酶(ALP)对胸主动脉腔内修复术(TEVAR)后疗效的预测价值。方法：回顾性分析2013年2月至2019年12月期间在我院接受TEVAR手术患者的临床资料。所有患者根据术前ALP水平，以中位数77.7 U/L为临界值分为低ALP水平组(第一组)和高ALP水平组(第二组)。比较两组患者术后复合事件的发生率，复合事件被定义为TEVAR术后1年内存在以下一种或多种情况：心肌梗死、脑血管意外、需要血液透析、肺部并发症、器官衰竭、感染和死亡，并逐步用Logistic回归分析评价复合事件发生率的预测因素。结果：两组复合事件的发生率分别是28.3%、45.1% (P = 0.002)。第二组ALP水平([OR] 1.393, 95%[CI] 1.049~1.735, P = 0.019)是复合事件发生率的独立预测因素。结论：在接受TEVAR的患者中，术前高ALP水平与不良结局间存在着独立的关系，这可能提示ALP作为危险分层有着潜在的作用。

Abstract: Objective: To explore the predictive value of preoperative serum alkaline phosphatase (ALP) level for efficacy after thoracic endovascular aortic repair (TEVAR). Methods: Clinical data of patients undergoing TEVAR in our hospital from February 2013 to December 2019 were retrospectively analyzed. All patients were divided into low ALP group (group 1) and high ALP group (group 2) according to preoperative ALP level and median 77.7 U/L as the critical value. The incidence of postoperative compound events was compared between the two groups, which were defined as the presence of one or more of the following: myocardial infarction, cerebrovascular accident, need hemodialysis, pulmonary complication, organ failure, infection and mortality within 1 year after TEVAR, and stepwise logistic regression analysis was performed to evaluate the predictors for compound events. Results: The incidence of compound events was 28.3% in group 1, 45.1% in group 2 (P = 0.002). The ALP level ([OR] 1.393, 95%[CI] 1.049~1.735, P = 0.019) in group 2 was an independent predictor of compound events. Conclusion: There is an independent relationship between high preoperative ALP levels and adverse outcomes in patients undergoing TEVAR, which may suggest a potential role of ALP level as a risk stratification.