| Objectives:1.To analyze the differences of ankle-brachial index(ABI),inter-arm systolic blood pressure difference(IASBPD)and inter-leg systolic blood pressure difference(ILSBPD)between patients with acute aortic dissection and healthy subjects.2.To investigate the predictive effect of ABI,IASBPD and ILSBPD on acute aortic dissection.3.To analyze the difference of ABI,IASBPD and ILSBPD between patients who survived and those who died in hospital with aortic dissection.4.To investigate the predictive effect of ABI,IASBPD and ILSBPD on nosocomial death in patients with acute aortic dissection.5.To analyze the influencing factors of ABI,IASBPD,ILSBPD in patients with acute aortic dissection.Methods:1.From October 2019 to December 2020,the medical records of 180 patients with acute aortic dissection diagnosed in the emergency department of a hospital in Wuhan were collected by case-control study method,and the patients with aortic dissection were included in the case group.We selected 180 healthy people with the same gender,difference in age of ±5 years and difference in body mass index(BMI)of ±5% from the physical examination center of the hospital during the same period as the control group.Medical records of the case group and the control group were collected retrospectively.We collected their general information,limb blood pressure measurements,ABI,IASBPD,ILSBPD,symptoms in patients with aortic dissection,Stanford parting,false lumen tear range score,treatment,and the outcomes.2.The study used the 2019 vesion of Excel to establish the database and SPSS 23.0software as a data analysis tool.Receiver operating characteristic curve(ROC)was calculated to evaluate the diagnostic value and prognosis prediction value of ABI,IASBPD and ILSBPD for aortic dissection.By comparing the area under curve(AUC),when it was greater than 0.7 indicated that the diagnostic effect was great.The truncation value corresponding to the maximum Youden index was selected to obtain the corresponding sensitivity and specificity.Regarding the influencing factors of ABI,IASBPD and ILSBPD in patients with aortic dissection,the study adopted the method of multiple linear stepwise regression.P<0.05 indicated a statistically significant difference.Results:1.In comparison with the control group,SBP and DBP at the higher side of the upper brachial artery,IASBPD and ILSBPD in patients with acute aortic dissection were significantly higher,and ABI level was significantly lower,the differences were statistically significant(P < 0.05).2.ROC curve analysis showed that the cutoff value of ABI for predicting acute aortic dissection was 0.90,AUC was 0.714,95% confidence interval was 0.659 to 0.769,sensitivity was 53.3%,specificity was 87.2%,and the maximum Youden index was0.406.The cutoff value of IASBPD for predicting acute aortic dissection was 10.00,AUC was 0.779,95% confidence interval was 0.730 to 0.828,sensitivity was 61.7%,specificity was 88.9%,and maximum Youden index was 0.506.The cutoff value of ILSBPD for predicting acute aortic dissection was 13.00,AUC was 0.673,95%confidence interval was 0.617 to 0.729,sensitivity was 50.6%,specificity was 80.6%,and the maximum Youden index was 0.311.Taking ABI cutoff value 0.9 as the boundary,54 cases(15.0%)were detected in ABI≤0.9,2 cases(1.1%)in the control group,and 52 cases(28.9%)in the aortic dissection group.As for the detection rate of ABI ≤ 0.9 in different groups,the differences were statistically significant(P < 0.001).IASBPD ≥ 10 mm Hg was detected in 117 cases(32.5%),15 cases(8.3%)in the control group,and 102 cases(56.7%)in the aortic dissection group.As for the detection rate of IASBPD ≥10mm Hg in different groups,the differences were statistically significant(P <0.001).A total of 128 cases(35.6%)were detected with ILSBPD≥13mm Hg,38 cases(21.1%)were detected in the control group,and 90 cases(50.0%)were detected in the aortic dissection group.As for the detection rate of ILSBPD≥13mm Hg in different groups,the differences were statistically significant(P<0.001).The detection rate of ABI ≤ 0.9,the detection rate of IASBPD ≥ 10 mm Hg and the detection rate of ILSBPD≥13mm Hg in aortic dissection group were significantly higher than those in control group.3.180 patients with acute aortic dissection were grouped according to their in-hospital outcomes.ABI,IASBPD and ILSBPD of the two groups were compared.31 patients in the death group(17.2%)and 149 patients in the survival group(82.8%)were compared.There was no statistical significance in their general information,SBP,IASBPD and other clinical characteristics in different groups(P>0.05).While the classification of aortic dissection,treatment methods,false lumen tear range score,DBP,ABI and ILSBPD were significantly different(P<0.05).Patients who died in hospital had lower ABI and higher ILSBPD.4.ROC curve analysis showed that the cutoff value of ABI for predicting nosocomial death in patients with acute aortic dissection was 0.80,AUC was 0.686,95%confidence interval was 0.561 to 0.811,sensitivity was 54.8%,specificity was 87.9%,and the maximum Youden index was 0.428.The cutoff value of IASBPD for predicting nosocomial death in patients with acute aortic dissection was 26.00 mm Hg,AUC was 0.489,95% confidence interval was 0.370 to 0.609,sensitivity was 25.5%,specificity was 82.6%,and the maximum Youden index was 0.084.The cutoff value of ILSBPD for predicting nosocomial death in patients with acute aortic dissection was20.00 mm Hg,AUC was 0.784,95% confidence interval was 0.698 to 0.870,sensitivity was 74.2%,specificity was 73.8%,and maximum Youden index was 0.480.Taking the cutoff value of ABI 0.8 as the boundary,29 cases(16.1%)of aortic dissection with ABI≤0.8 were detected,14 patients(9.4%)survived and 15 patients(48.4%)died in hospital.As for the detection rate of ABI≤0.8 in different groups,the differences were statistically significant(P < 0.001).Taking the cutoff value of IASBPD 26 mm Hg as the boundary,34 cases(18.9%)with IASBPD≥26mm Hg were detected in aortic dissection,29 patients(19.5%)survived and 5 patients(16.1%)died in hospital.As for the detection rate of IASBPD≥26mm Hg in different groups,the differences were not statistically significant(P > 0.05).Taking the cutoff value of ILSBPD 20 mm Hg as the boundary,a total of 62 patients(34.4%)with ILSBPD≥20mm Hg were detected in aortic dissection,39 patients(26.2%)survived and 23patients(74.2%)died in hospital.As for the detection rate of ILSBPD≥20mm Hg in different groups,the differences were statistically significant(P<0.001).5.In 180 patients with acute aortic dissection as the research object,by the univariate analysis and multiple linear stepwise regression analysis results showed that the false lumen range score was an independent factors of ABI(P<0.001),the false lumen range score and high blood pressure were independent factors of IASBPD(P<0.05),the false lumen tear score was the independent factor of ILSBPD(P<0.001).Conclusions:1.Compared with the healthy population,IASBPD and ILSBPD were significantly higher,and ABI was significantly lower in patients with acute aortic dissection.2.ABI≤0.9,IASBPD≥10mm Hg and ILSBPD≥13mm Hg can be used as indicators for early screening of acute aortic dissection,and had certain predictive value for the incidence and severity of aortic dissection.3.Compared with patients who survived in hospital with acute aortic dissection,patients who died in hospital had lower level of ABI and higher level of ILSBPD.4.ABI≤0.8 and ILSBPD≥20mm Hg had certain predictive value in determining the lesion range of acute aortic dissection and in-hospital death.5.False lumen tear range affected ABI,IASBPD,and ILSBPD levels in patients with acute aortic dissection.Hypertension affected IASBPD levels in patients with acute aortic dissection. |
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