河北医科大学学报 ›› 2025, Vol. 46 ›› Issue (5): 604-610.doi: 10.3969/j.issn.1007-3205.2025.05.018

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血小板蛋白激酶C活性与Stanford A型主动脉夹层患者Bentall术后短期预后的关系分析

  

  1. 1.河北北方学院附属第一医院检验科，河北 张家口 075000；2.河北北方学院附属第一医院检验科心血管内科，河北 张家 075000；3.河北北方学院附属第一医院检验科输血科，河北 张家口 075000

  • 出版日期:2025-05-25 发布日期:2025-05-23
  • 作者简介:李晓颖（1994-），女，河北张家口人，河北北方学院附属第一医院初级检验师，医学学士，从事临床检验诊断研究。

  • 基金资助:
    河北省医学科学研究课题计划（20200509）

Analysis of the relationship between platelet protein kinase C activity and short-term prognosis after Bentall surgery in patients with Stanford type A aortic dissection

  1. 1. Department of Laboratory, the First Affiliated Hospital of Hebei North University, Zhangjiakou 
    075000, China; 2.Department of Cardiovascular Medicine, the First Affiliated Hospital of 
    Hebei North University,Zhangjiakou  075000, China; 3.Department of Blood 
    Transfusion Department, the First Affiliated Hospital of 
    Hebei North University, Zhangjiakou 075000, China

  • Online:2025-05-25 Published:2025-05-23

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摘要： 目的 观察Stanford A型主动脉夹层（type A aortic dissection，TAAD）患者血小板蛋白激酶C（protein kinase C，PKC）活性情况，并分析其与患者Bentall术后短期预后的关系。
方法 选取2020年1月—2023年3月于河北北方学院附属第一医院拟行Bentall术治疗的TAAD患者216例为研究对象，均成功行Bentall术，根据术后30 d内不良事件发生情况评估预后，并分为预后不良组与预后良好组；统计2组一般资料、血小板PKC活性及其他实验室指标，重点分析血小板PKC活性与TAAD患者Bentall术后短期预后的关系。
结果 216例患者术后30 d内56例发生不良事件，不良事件发生率为25.93%（56/216）；预后不良组伴有心包积液（71.43%）、下肢缺血占比（33.93%）高于预后良好组（55.00%、20.00%），入院时舒张压［（72.29±4.58）mmHg（1 mmHg=0.133 kPa）］、细胞浆PKC活性［（192.86±9.66）pmol·min-1·mg-1］、血小板值［（181.24±17.53）×109/L］小于预后良好组［（74.83±4.26）mmHg、（201.51±9.21）pmol·min-1·mg-1、（190.79±20.51）×109/L］，血小板细胞膜PKC活性［（319.23±19.66）pmol·min-1·mg-1］、D-二聚体值［（527.87±14.14）μg/L］大于预后良好组［（297.52±15.48）pmol·min-1·mg-1、（519.58±13.37）μg/L］，差异有统计学意义（P＜0.05）；点二列相关性分析显示，血小板细胞浆PKC活性与TAAD患者Bentall术后短期预后不良风险呈负相关（r=-0.379，P＜0.05），血小板细胞膜PKC活性与患者术后短期预后不良风险呈正相关（r=0.498，P＜0.05）；Logistic回归分析发现，入院时舒张压、血小板细胞浆PKC活性、血小板细胞膜PKC活性及D-二聚体水平均为TAAD患者Bentall术后短期预后的影响因素（OR=0.844、0.867、1.069、1.069，P＜0.05）；受试者工作特征曲线分析发现，血小板细胞浆PKC活性、血小板细胞膜PKC活性单独及联合预测TAAD患者Bentall术后短期预后不良的曲线下面积分别为0.741、0.800、0.879，均有一定预测价值，且联合检测预测价值更高。
结论 血小板PKC活性与TAAD患者Bentall术后短期预后情况有关，血小板细胞浆PKC活性下降、血小板细胞膜PKC活性升高会增加患者术后短期预后不良发生风险，二者联合检测可辅助临床早期筛选预后不良高风险患者。


关键词: 主动脉疾病, 血小板蛋白激酶C, 预后

Abstract: Objective To observe the activity of platelet protein kinase C (PKC) in patients with Stanford type A aortic dissection (TAAD) and to analyze its relationship with short-term prognosis after Bentall surgery. 
Methods In total, 216 TAAD patients who planned to undergo Bentall surgery in  the First Affiliated Hospital of Hebei North University from January 2020 to March 2023 were selected as the research subjects. All patients successfully underwent Bentall surgery, and their prognosis was evaluated based on the occurrence of adverse events within 30 d after surgery. They were divided into a poor prognosis group and a good prognosis group. The general data, platelet PKC activity and other laboratory indexes of the two groups were statistically analyzed, and the relationship between platelet PKC activity and short-term prognosis of TAAD patients after Bentall surgery was analyzed. 
Results Adverse events occurred in 56 of 216 patients within 30 d after surgery, and the incidence of adverse events was 25.93% (56/216). The proportion of pericardial effusion (71.43%) and lower limb ischemia (33.93%) in the poor prognosis group was higher than that in the good prognosis group (55.00%, 20.00%). The diastolic blood pressure (DBP) on admission ［(72.29±4.58) mmHg］,  platelet cytoplasmic PKC activity ［(192.86±9.66) pmol·min-1·mg-1］, and platelet count ［(181.24±17.53)×109/L］ were lower than those in the good prognosis group ［(74.83±4.26) mmHg, (201.51±9.21) pmol·min-1·mg-1, (190.79±20.51)×109/L］. The PKC activity of platelet membrane ［(319.23±19.66) pmol·min-1·mg-1］ and D-dimer (DD) value ［(527.87±14.14) μg/L］ were higher than those in the good prognosis group ［(297.52±15.48) pmol·min-1·mg-1, (519.58±13.37) μg/L］, with significant differences (P＜0.05). Point-biserial correlation analysis showed that platelet cytoplasmic PKC activity was negatively correlated with the risk of short-term adverse prognosis in TAAD patients after Bentall surgery (r=-0.379, P＜0.05), while PKC activity of platelet membrane was positively correlated with the risk of short-term adverse prognosis in TAAD patients after surgery (r=0.498, P＜0.05). Logistic regression analysis found that DBP, platelet cytoplasmic PKC activity, PKC activity of platelet membrane, and DD levels at admission were all influencing factors for the short-term prognosis of TAAD patients after Bentall surgery (OR=0.844, 0.867, 1.069, 1.069, P＜0.05). The analysis of the receiver operating curve (ROC) revealed that the areas under the curve of platelet cytoplasmic PKC activity and PKC activity of platelet membrane, both alone and in combination, for predicting short-term poor prognosis in TAAD patients after Bentall surgery were 0.741, 0.800, and 0.879, respectively,with certain predictive value, and the combined detection had higher predictive value. 
Conclusion Platelet PKC activity is related to the short-term prognosis of TAAD patients after Bentall surgery. The decrease in platelet cytoplasmic PKC activity and the increase in PKC activity of platelet membrane increase the risk of poor short-term prognosis in patients after surgery. Combined detection of the two can assist in early clinical screening of high-risk patients with poor prognosis. 


Key words: Aortic dissection, Stanford type A, Platelet protein kinase C, Prognosis, Correlation

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