二叶式主动脉瓣合并升主动脉扩张患者根部扩张的影响因素  

Study on risk factors of sinus dilation in bicuspid aortic valve patients accompanied with dilated ascending aorta

作　　者：王斌[1] 杨守国[1] 陈昊[1] 吴俊[1] 洪涛[1] 王春生[1] 

机构地区：[1]复旦大学附属中山医院上海心血管病研究所心外科,200032

出　　处：《中华胸心血管外科杂志》2013年第12期709-713,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家“十二五”科技支撑计划（2011BA11B20）

摘　　要：目的回顾性研究已发生升主动脉近段扩张患者的病案信息，探索影响根部扩张的相关因素。方法收集2003年1月1日至2011年5月4日间二叶式主动脉瓣并升主动脉扩张而行手术治疗的患者的所有病案信息，排除合并夹层和信息不完整者。共66例患者入选，按主动脉根部内径是否〉45mm分为增宽组和非增宽组。所有资料应用SPSS20．0进行相关统计分析，交叉表和独立分组t检验模型行单因素分析，二元logistic回归模型行多因素分析，ROC曲线模型进行诊断决策分析。结果单因素分析提示：增宽组较非增宽组，男性比例高、年龄小、身高高、症状持续时间短、横裂式畸形比例高、瓣膜反流程度高、狭窄程度低、左室舒张期末／收缩期末内径大、左心室射血分数低、总胆红素／直接胆红素／尿素氮高。多因素分析提示：狭窄程度小、左心室舒张期末内径大为根部增宽〉45mm的显著危险因素。ROC曲线分析提示：左心室舒张末期内径和收缩末内径对根部增宽诊断价值最大，舒张期末内径〉60mm、收缩期末内径〉45mm时诊断灵敏度为0．93和0．79，特异度为0．83和0．89。结论狭窄程度小、左心室舒张末内径大是二叶式主动脉瓣合并升主动脉扩张患者出现根部扩张〉45mm的显著危险因素，左室收缩末、舒张末内径可有效诊断根部增宽与否。Objective Aortic dilation in bicuspid aortic valve patients usually begins at the proximal tubular ascending aorta. This study, we investigate the risk factors of aortic root dilation, in advantage of reviewing medical records of bicuspid aortic valve patients with dilated ascending aorta. Methods Include all the bicuspid aortic valve patients with dilated proximal ascending aorta who needed surgical intervention from Jan l , 2003 to May 4, 2011. We exclude patients accompanied with aor- tic dissection or without echocardiographie report. Divide these patients into group dilation （ i〉45 ram） and group non-dilation （ 〈 45 mm） according to sinus diameters and proceed statistical analysis in SPSS 20.0. Results In univariate analysis, group dilation are younger and higher, and possess higher proportion of male and fusion of fight-lefi coronary cusps, more severe aor- tic regurgitation, larger left ventricular diameters and higher elevation of total bilirubin, conjugated bilirubin and creatinine, but shorter duration of symptoms, less aortic stenosis and lower ejection fraction. In multivariate analysis with logistic regression model, less aortic stenosis and larger left ventricular end-diastolic diameter are the significant risks of sinus dilation. It＇s dem- onstrated in ROC curve analysis, that left ventrieular systolic diameter and diastolic diameter are the two most valuable parame- ters indicating sinus dilation, the sensitivity and specificity is 0.93,0.83 while left ventricular diastolic diameter 〉 60 mm and 0.79, 0.89 while systolic diameter 〉 45 ram. Conclusion Less aortic stenosis and larger left ventricular end-diastolic diame- ter are the significant risks of aortic root dilation in bicuspid aortic valve patients accompanied with dilated ascending aorta. The left ventricular systolic and diastolic diameters are the most valuable parameters indicating aortic root dilation.

关 键 词：主动脉瓣 主动脉疾病 主动脉根部 横裂式 

分 类 号：R654.2[医药卫生—外科学]