| Objective: Exploring the effects of hematological indicators such as D-dimer(D-D),fibrinogen degradation products(FDP),and blood urea nitrogen(BUN)on acute aortic syndrome(AAS),including acute aortic dissection(AAD)The clinical application value of early differential diagnosis,disease progression,and prognosis of penetrating aortic ulcer(PAU)and aortic intramural hematoma(IMH).Methods: A retrospective analysis was conducted on 78 hospitalized patients with acute aortic syndrome from January 2019 to August 2022,including 35 patients in the AAD group,13 patients in the IMH group,and 30 patients in the PAU group.Dynamic data on D-D,FDP,BUN,and other hematological indicators of patients with acute aortic syndrome were collected for inter group comparison.The comparison of hematological indicators among the three groups at admission was conducted using ANOVA or Mann Whitney rank sum test based on the distribution of data as normal or skewed.The difference in hematological indicators between AAS patients before and after surgery was compared using paired t-test and paired sign rank sum test.According to the follow-up results,AAS patients were divided into survival group and death group,and Cox regression analysis was used to explore the relevant risk factors for the prognosis of AAS patients.All data were analyzed with SPSS 27.0 statistical software,in which the count data of normal distribution were calculated with mean ± standard deviation(x ? ± s),and the skewed distribution data is represented by the median(lower quartile,upper quartile).Results: 1.Comparison of D-D levels at admission between AAD,PAU,and IMH groups.The D-D levels of AAD patients were 5.42(2.48,8.71)ug/ml,PAU patients were 2.77(1.33,4.74)ug/ml,and IMH patients were 1.19(0.60,3.06)ug/ml.The D-D levels of AAD group were significantly higher than those of PAU group,with statistical significance(p<0.05);The D-D level in the AAD group was significantly higher than that in the IMH group,and the difference was statistically significant(p<0.05).The D-D levels in the PAU group were higher than those in the IMH group,but the difference between the two groups was not statistically significant(p>0.05).2.Comparison of FDP levels at admission between AAD,PAU,and IMH groups showed that the FDP levels of AAD patients were 17.00(9.36,22.61)ug/ml,PAU patients were 7.97(3.13,13.03)ug/ml,and IMH patients were 5.00(2.75,9.02)ug/ml.The FDP level in the AAD group was significantly higher than that in the PAU group,with a statistically significant difference(p<0.05);The FDP level in the AAD group was significantly higher than that in the IMH group,and the difference was statistically significant(p<0.05).The FDP level in the PAU group was higher than that in the IMH group,and the difference was not statistically significant(p>0.05).3.Through receiver operating characteristic curve(ROC)analysis,it was found that D-D ≥ 1.91ug/ml and FDP ≥ 11.225 ug/ml are the optimal critical values for distinguishing AAD patients from PAU+IMH patients.The areas under the ROC curve are 0.740 and 0.778 respectively,and the areas under the ROC curve are between 0.7 and1.0,indicating that D-D and FDP detection have certain clinical value in the diagnosis of AAD.Meanwhile,the sensitivity and specificity of D-D were 94.3% and 48.8%,respectively;The sensitivity and specificity of FDP are 71.4% and 74.4%,respectively.The correlation coefficient between D-D and FDP is 0.941(p<0.001),which is significant and statistically significant.The bivariate regression equation is D-D=2.257+0.16 × FDP,which indicates that in AAS,for every 1 unit increase in FDP,D-D will increase by 0.16.The D-D level increases with the increase of FDP level.5.Before and after surgical treatment for AAS patients,D-D,FDP,White blood cell count(WBC),Neutrophil count(NEUT),Lymphocyte count(LYMP),Monocyte count(MONO),Red blood cell count(RBC),Hemoglobin(HB),Total bilirubin(TBI)Indirect bilirubin(IBI)and blood urea nitrogen(BUN)showed statistically significant differences(p<0.05).The levels of D-D,FDP,WBC,NEUT,MONO,and BUN were significantly increased on the first postoperative day compared to before surgery,while the levels of LYMP,RBC,HB,TBI,and IBI were significantly reduced on the first postoperative day compared to before surgery.6.Through multivariate COX regression analysis,FDP(HR=1.048,95% CI 1.017-1.080,p=0.002)and BUN(HR=1.186,95% CI 1.020-1.380,p=0.026)were independent risk factors for death in AAS patients.7.Through ROC analysis,it was found that FDP ≥ 7.735ug/ml and BUN ≥ 6.485 mmol/L were the optimal critical values for predicting death in AAS patients.The areas under the ROC curve were 0.728 and 0.766,respectively,and both were between 0.7 and 1.0.This suggests that D-D and FDP detection have certain clinical value in predicting death in AAS patients.The sensitivity and specificity of FDP were 88.9% and 54.2%,respectively;The sensitivity and specificity of BUN are 66.7%and 79.2%,respectively.8.Prothrombin time(PT),Activated partial thromboplastin time(APTT),Thrombin time(TT),Fibrinogen(FIB),Antithrombin III(AT-III),WBC,NEUT,LYMP,MONO,RBC,HB,Platelet count(PLT),Platelet crit(PCT)Mean platelet volume(MPV),total bilirubin(TBI),direct bilirubin(DBI),indirect bilirubin(IBI),alanine transaminase(ALT),alkaline phosphatase(ALP),aspartate aminotransferase(AST),albumin(ALB)Glutamyl transpeptidase(GGT),creatinine,uric acid,high-density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein A1(APOA1)No specific clinical application value for the diagnosis and prognosis of AAS has been found in hematological indicators such as lipoprotein a(Lp(a)).Conclusion: The levels of D-D and FDP are significantly elevated in acute aortic syndrome,which can serve as reference hematological indicators for early diagnosis of acute aortic syndrome.There are significant statistical differences in D-D and FDP levels between acute aortic dissection and intramural hematoma,as well as between acute aortic dissection and penetrating aortic ulcer.D-D and FDP levels have certain application value in the diagnosis and differential diagnosis of acute aortic dissection and intramural hematoma,as well as acute aortic dissection and penetrating aortic ulcer.Elevated levels of FDP and BUN at admission may be independent predictors of poor prognosis and increased risk of death in patients with acute aortic syndrome.WBC,NEUT,LYMP,MONO,PLT,PCT,MPV,bilirubin,uric acid,blood lipids and other hematological indicators have not been found to be specific in the diagnosis and prognosis of acute aortic syndrome,and their practical application value is limited. |
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