2022 年第 9 期 第 17 卷

冷诱导RNA结合蛋白对主动脉夹层全弓置换术后神经系统并发症的影响

Effect of cold-inducible RNA-binding protein on neurological complications after total aortic dissection replacement

作者：曹先通1吴玉静2郑幸龙1刘淼淼1徐晓芸3周和平1

英文作者：Cao Xiantong1 Wu Yujing2 Zheng Xinglong1 Liu Miaomiao1 Xu Xiaoyun3 Zhou Heping1

单位：1西安交通大学第一附属医院心血管外科，西安710000；2西安交通大学第一附属医院急诊科，西安710000；3宁夏中医医院暨中医研究院影像科，银川750000

英文单位：1Department of Cardiovascular Surgery the First Affiliated Hospital of Xi′an Jiaotong University Xi′an 710000 China; 2Department of Emergency the First Affiliated Hospital of Xi′an Jiaotong University Xi′an 710000 China; 3Department of Imaging Ningxia Traditional Chinese Medicine Hospital and Research Institute of Traditional Chinese Medicine Yinchuan 750000 China

关键词：主动脉夹层；冷诱导RNA结合蛋白；体外循环；神经系统并发症

英文关键词：Aorticdissection；Cold-inducibleRNA-bindingprotein；Cardiopulmonarybypass；Neurologicalcomplications

• 摘要：

• 目的 探索冷诱导RNA结合蛋白（CIRP）对中低温停循环主动脉夹层全弓置换手术后患者神经系统并发症的影响。方法  选取2021年1—3月在西安交通大学第一附属医院行外科手术治疗的急性A型主动脉夹层患者68例。根据术后是否发生短暂性神经系统并发症（TND）将患者分为TND组（12例）和非TND组（56例）；根据术后是否发生永久性神经系统并发症（PND），将患者分为PND组（8例）和非PND组（60例）。记录患者的临床资料，采用二元Logistic回归模型，分析主动脉夹层全弓置换术后出现神经系统并发症的危险因素。结果  TND组体外循环后血清CIRP水平高于非TND组［（2 311±936）ng/L比（1 313±528）ng/L］，差异有统计学意义（P＜0.05）。PND组体外循环时间长于非PND组［（172±33）min比（139±27）min］，差异有统计学意义（P＜0.05）。二元Logistic回归分析结果显示，体外循环后血清CIRP水平是A型主动脉夹层患者中低温停循环全弓置换术后出现TND的独立危险因素（比值比=1.002，95%置信区间：1.001~1.004，P=0.008），而体外循环时间不是术后出现PND的危险因素（比值比=1.074,95%置信区间：0.990~1.165，P=0.085）。结论 体外循环后血清CIRP水平是A型主动脉夹层患者中低温停循环全弓置换术后出现TND的独立危险因素，但与PND无关。

• Objective  To investigate the effect of cold-inducible RNA-binding protein (CIRP) on neurological complications after moderate hypothermic circulatory arrest and total aortic dissection replacement. Methods  Totally 68 patients with acute type A aortic dissection admitted to the First Affiliated Hospital of Xi′an Jiaotong University from January to March 2021 were enrolled. According to occurrence of transient neurological diseases (TND) after operation, patients were divided into TND group (12 cases) and non-TND group (56 cases); according to occurrence of permanent neurological diseases (PND), patients were divided into PND group (8 cases) and non-PND group (60 cases). The clinical data of patients were recorded, and risk factors of postoperative neurological complications after moderate hypothermic circulatory arrest and total aortic dissection replacement were analyzed by bivariate Logistic regression model. Results  The serum level of CIRP after cardiopulmonary bypass (CPB) in TND group was higher than that in non-TND group ［（2 311±936）ng/L vs （1 313±528）ng/L］(P<0.05). The CPB duration in PND group was longer than that in non-PND group ［（172±33）min vs （139±27）min］(P<0.05). Bivariate Logistic regression analysis showed that the serum level of CIRP after CPB was a risk factor of postoperative TND in patients with type A aortic dissection undergoing moderate hypothermic circulatory arrest and total aortic dissection replacement(odds ratio=1.002, 95% confidence interval: 1.001-1.004, P=0.008), and CPB duration was not a risk factor of postoperative PND (odds ratio=1.074, 95% confidence interval: 0.990-1.165, P=0.085). Conclusion  The serum level of CIRP after CPB was a risk factor of postoperative TND in patients with type A aortic dissection undergoing moderate hypothermic circulatory arrest and total aortic dissection replacement, while there is no association with PND.