中国北方人群主动脉穿透性溃疡的临床研究  

Clinical study of patients with penetrating aortic ulcer in the North of China

作　　者：杨霖 刘艳杰 王效增 周铁楠 刘海伟 荆全民 YANG Lin;LIU Yan-jie;WANG Xiao-zeng;ZHOU Tie-nan;LIU Hai-wei;JING Quan-min(Cardiovascular Institute of Chinese PLA,North Theater General Hospital,Shenyang 110016,China)

机构地区：[1]北部战区总医院心血管内科

出　　处：《岭南心血管病杂志》2019年第3期317-321,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨主动脉穿透性溃疡(penetrating aortic ulcer,PAU)的临床特点,评价药物及介入治疗的近远期疗效。方法回顾性分析2004年11月至2017年10月就诊于北方战区总医院心内科和急诊科的148例PAU患者,根据是否接受主动脉腔内修复术(endovascular aneurysm repair,EVAR)分为EVAR组和药物治疗组,对两组临床及影像学表现、近远期疗效进行分析。结果(1)临床及计算机断层扫描血管造影(CTA)资料:与药物治疗组相比,EVAR组胸降主动脉溃疡患者比例较高(73.26%vs.50.00%,P=0.004),溃疡直径较大[(21.31±1.75)mmvs.(7.30±3.27)mm,P<0.001]及溃疡深度较深[(13.68±2.29)mmvs.(5.73±3.73)mm,P<0.001],差异有统计学意义。两组在性别比例、烟酒史、其他并存疾病及其在院用药等方面比较,差异均无统计学意义(P>0.05)。(2)近期随访情况:EVAR组发热患者比例高于药物治疗组,差异有统计学意义(36.47%vs.10.20%,P<0.001)。两组其他近期并发症比较,差异无统计学意义(P均>0.05)。(3)远期随访情况:随访率为93.2%,两组患者病死率比较,差异无统计学意义(9.09%vs.3.33%,P=0.177)。两组患者临床症状、并发症发生率比较,差异均无统计学意义(P均>0.05)。(4)多因素回归分析显示,积极行EVAR是预防主动脉不良事件发生的独立因素。结论对于持续性疼痛、存在破裂风险、溃疡直径≥20mm或溃疡深度≥10mm及溃疡持续进展的PAU患者应积极行EVAR治疗,可获得与较小溃疡药物治疗相同的临床疗效;积极行EVAR是预防主动脉不良事件发生的独立危险因素。Objectives To analyze the clinical characteristics and evaluate the short- term and long- term clinical efficacy of endovascular aneurysm repair (EVAR) and medical treatment in patients with penetrating aortic ulcer (PAU). Methods From November 2004 to October 2017,a total of 148 patients who were diagnosed as PAU in North Theater General Hospital. According to whether they received EVAR,they were divided into two groups:EVAR group and drug treatment group. The clinical and image characteristics of the two groups were analyzed. The short-and long-term outcomes were analyzed. Results (1) Clinical and computed tomography angiography (CTA) data: percentage of patients with aoetic ulcer(73.26% vs. 50.00%,P<0.001),diameter of ulcers[(21.31±1.75)mm vs.(7.30±3.27) mm,P<0.001] and depth of ulceration[(13.68±2.29) mm vs.(5.73±3.73) mm,P<0.001] were significantly higher in EVAR group than those in drug treatment group. There were no significant differences in sex ratio,history of tobacco and alcohol,and the other coexisting diseases between the two groups(P>0.05).(2)Short term term follow-up results:percentage of patients with fever in EVAR group was significantly higher than that in drug treatment group (36.47% vs. 10.20%, P<0.001). There were no significant differences in other short- term complications between the two groups (P>0.05).(3)Long term follow- up results: Among the 147 discharged patients,137 patients were followed up(93.2%),and 10 patients were lost to follow-up. There was no significant difference in mortality between the two groups(9.09% vs. 3.33%,P=0.177). There was no significant difference in clinical symptoms and complication rates between the two groups (P>0.05).(4) Multivariate regression analysis showed that active EVAR is an independent prevention predictor for aorta-related events. Conclusions For persistent pain,the risk of rupture,the diameter of the ulcer ≥20 mm or the depth of ulceration ≥10 mm and the continuous progression of the ulcer should be actively treated by EVAR,which can obt

关 键 词：主动脉穿透性溃疡 主动脉腔内修复术 疗效 

分 类 号：R543.1[医药卫生—心血管疾病]