术前淋巴细胞/单核细胞比值与急性A型主动脉夹层患者术后预后的相关性研究

摘要/Abstract

摘要： 目的探讨术前淋巴细胞/单核细胞比值（lymphocyte-to-monocyte ratio，LMR）与急性A型主动脉夹层（acute Stanford type A aotic dissection，ATAAD）患者术后短期及长期预后的相关性。方法选择本院2021年1月至2024年1月期间在本院接受手术治疗的100例ATAAD患者作为研究对象，术前检测外周血中淋巴细胞和单核细胞，计算LMR。记录患者术后住院期间死亡情况并随访术后1年死亡情况。采用单因素和多因素Logistic回归分析影响患者短期和长期死亡的危险因素，并采用受试者工作特征（receiver operating characteristic，ROC）曲线和曲线下面积（aera under curve，AUC）评价术前LMR预测AAD患者短期和长期预后的效能。结果 100例患者术后30 d内死亡26例（26.00%），术后1年内死亡42例（42.00%）。单因素和多因素Logistic回归分析结果显示，入院时WBC[OR=1.881（95%CI：1.121-3.156）]、LYM[OR=0.415（95%CI：0.235-0.734）]和LMR[OR=0.398（95%CI：0.231-0.687）]是ATAAD患者术后30 d内死亡的独立影响因素，入院时LYM[OR=0.394（95%CI：0.268-0.578）]和LMR[OR=0.296（95%CI：0.186-0.471）]是ATAAD患者术后1年内死亡的独立影响因素（P<0.05）。ROC曲线结果显示，入院时LYM和LMR预测ATAAD患者术后30 d死亡的AUC分别为0.713和0.745，最佳预测阈值分别为1.045×10⁹/L和1.8，灵敏度分别为73.08%和88.46%，特异度分别为60.81%和52.70%;入院时LYM和LMR预测ATAAD患者术后1年死亡的AUC分别为0.813和0.886，最佳预测阈值分别为0.675×10⁹/L和1.525，灵敏度分别为57.14%和85.71%，特异度分别为94.83和77.59%。结论术前LMR是ATAAD患者短期和长期预后的独立影响因子，可作为短期和长期死亡的预测指标。

关键词: 急性A型主动脉夹层, 淋巴细胞/单核细胞比值, 预后, 相关性

Abstract: Objective To investigate the association of preoperative lymphocyte-to-monocyte ratio (LMR) with short- and long-term prognosis in patients with acute type A aortic dissection (ATAAD). Methods A total of 100 patients with ATAAD who underwent surgical treatment in our hospital from January 2021 to January 2024 were enrolled as subjects. Peripheral blood lymphocytes and monocytes were measured before surgery, and LMR was calculated. Death during hospitalization after surgery was recorded, and the patients were followed up for 1 year after surgery to record deaths. Univariate and multivariate logistic regression analyses were used to investigate the risk factors for short- and long-term mortality in patients, and the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to assess the efficacy of preoperative LMR in predicting the short- and long-term prognosis of patients with ATAAD. Results Among the 100 patients, 26 (26.00%) died within 30 days after surgery, and 42 (42.00%) died within 1 year after surgery. The univariate and multivariate logistic regression analyses showed that white blood cell count (odds ratio [OR]=1.881, 95% confidence interval [CI]: 1.121-3.156, P<0.05), lymphocyte count (LYM) (OR=0.415, 95%CI: 0.235-0.734, P<0.05), and LMR (OR=0.398, 95%CI: 0.231-0.687, P<0.05) on admission were independent influencing factors for death within 30 days after surgery in ATAAD patients, and LYM (OR=0.394, 95%CI: 0.268-0.578, P<0.05) and LMR (OR=0.296, 95%CI: 0.186-0.471, P<0.05) on admission were independent influencing factors for death within 1 year after surgery in ATAAD patients. The ROC curve analysis showed that LYM and LMR on admission had an AUC of 0.713 and 0.745, respectively, in predicting death within 30 days after surgery in ATAAD patients, with an optimal prediction threshold of 1.045×10⁹/L and 1.8, respectively, a sensitivity of 73.08% and 88.46%, respectively, and a specificity of 60.81% and 52.70%, respectively; LYM and LMR on admission had an AUC of 0.813 and 0.886, respectively, in predicting death within 1 year after surgery in ATAAD patients, with an optimal prediction threshold of 0.675×10⁹/L and 1.525, respectively, a sensitivity of 57.14% and 85.71%, respectively, and a specificity of 94.83% and 77.59%, respectively. Conclusion Preoperative LMR is an independent influencing factor for both short- and long-term prognoses in ATAAD patients and can be used as a predictive indicator for short- and long-term mortality.

Key words: Acute type A aortic dissection, Lymphocyte-to-monocyte ratio, Prognosis, Association

熊辉, 钱啸宇, 司璐意. 术前淋巴细胞/单核细胞比值与急性A型主动脉夹层患者术后预后的相关性研究[J]. 心血管病防治知识, 2025, 15(20): 23-29.

XIONG Hui, QIAN Xiaoyu, SI Luyi. Association between preoperative lymphocyte-to-monocyte ratio and postoperative prognosis in patients with acute type A aortic dissection[J]. Prevention and Treatment of Cardiovascular Disease, 2025, 15(20): 23-29.

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