Stanford B型创伤性主动脉夹层患者术后血清NF-κB水平变化对早期主动脉不良事件的预测价值OA

Aim To explore the correlation between postoperative serum nuclear factor-κB(NF-κB)level chan-ges and early aortic adverse events(AAE)as well as its predictive value in patients with Stanford type B traumatic aortic dissection(TBAD),so as to provide a theoretical basis for early clinical identification of postoperative AAE risk.Methods A total of 159 patients with TBAD admitted to our hospital from April 2021 to August 2024 were retrospectively enrolled,and 146 patients were finally included according to the inclusion and exclusion criteria.All patients were divid-ed into AAE group(n=47)and non-AAE group(n=99)based on the occurrence of postoperative AAE.Meanwhile,150 cases were randomly selected via the random number table method from 364 patients with non-traumatic aortic dissec-tion receiving thoracic endovascular aortic repair,who were assigned to the non-TBAD group.Repeated-measures analysis of variance was used to compare NF-κB levels before surgery,1 month and 3 months after surgery.Dose-response plots were generated to analyze the correlation between the reduction in NF-κB levels(ΔNF-κB)and the probability of false lu-men thrombosis.A generalized linear mixed model(GLMM)was employed to analyze the correlation between ΔNF-κB and the risk of AAE.ROC curves were used to evaluate the predictive performance of ΔNF-κB for AAE.Restricted cu-bic spline(RCS)models were used to analyze the association between ΔNF-κB and AAE risk.The R package Interplot was used to generate interaction plots of ΔNF-κB with false lumen thrombosis degree on AAE risk.The Kaplan-Meier method was used to plot survival curves to evaluate the occurrence of AAE in patients with different levels of ΔNF-κB.Results The 1-month postoperative NF-κB decreased level(ΔNF-κB1)in the AAE group was 0.69-fold and 0.76-fold that of the non-TBAD and non-AAE groups,respectively,while the3-month postoperative decreased level(ΔNF-κB2)was 0.74-fold and 0.80-fold,respectively(P<0.05).The dose-dependent plot results showed that the probability of false lu-men thrombosis formation gradually increased with the elevation of ΔNF-κB1 and ΔNF-κB2 in the AAE group,and tended to stabilize when ΔNF-κB1>0.62 μg/L or ΔNF-κB2>0.69 μg/L.GLMM analysis showed that compared with ΔNF-κB1<0.15 μg/L,ΔNF-κB1<0.56 μg/L was positively associated with AAE risk,and ΔNF-κB1≥0.56 μg/L was negatively as-sociated with AAE risk(P<0.05).Compared with ΔNF-κB2<0.18 μg/L,ΔNF-κB2<0.66 μg/L was positively correla-ted with AAE risk,and ΔNF-κB2≥0.66 μg/L was negatively correlated with AAE risk.ROC analysis showed that the AUC of ΔNF-κB1 for predicting AAE was 0.784(95%CI:0.710～0.859,P<0.001),and the best cut-off value was 0.62 μg/L;the AUC of ΔNF-κB2 for predicting AAE was 0.811(95%CI:0.741～0.881,P<0.001),and the best cut-off value was0.69 μg/L,suggesting that ΔNF-κB2 had a stronger predictive performance for AAE.RCS model analy-sis showed that with the increase of ΔNF-κB1 and ΔNF-κB2,the risk of AAE showed a decreasing trend(P<0.05).The interaction diagram showed that the negative correlation between false lumen thrombosis degree and AAE risk was enhanced along with the increase of NF-κB reduction magnitude.The Kaplan-Meier survival curve showed that there was a statisti-cally significant difference in the incidence of AAE among patients with different levels of ΔNF-κB1 and ΔNF-κB2(χ2=5.064,P=0.028),and patients with higher ΔNF-κB levels had a lower incidence of AAE.Conclusion Postopera-tive reduction of serum NF-κB level can effectively predict the risk of early AAE in TBAD patients,which is negatively cor-related with the AAE risk,and this mechanism may be mediated by promoting false lumen thrombosis.