经保守治疗A型主动脉壁内血肿的死亡相关危险因素分析  

Analysis of risk factors related to death in type A aortic intramural hematoma with conservative therapy

作　　者：陈远 李震南[1] 安云强 侯志辉[1] 高扬[1] 尹卫华[1] 于易通 吕滨[1] Chen Yuan;Li Zhennan;An Yunqiang;Hou Zhihui;Gao Yang;Yin Weihua;Yu Yitong;Lyu Bin(Department of Radiology,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,阜外医院放射影像科,100037

出　　处：《中华放射学杂志》2020年第3期198-202,共5页Chinese Journal of Radiology

基　　金：国家重点研发计划(2016YFC1300400);协和医学院创新工程(2016-I2M-1-011)。

摘　　要：目的探讨保守治疗的A型主动脉壁内血肿(IMH)患者死亡的危险因素,为临床危险分层和治疗决策提供依据。方法回顾性搜集2009年9月至2018年6月在中国医学科学院阜外医院入院,首次CT检查中确诊为A型IMH且只接受药物治疗的患者,共130例。搜集患者的临床和影像资料并进行随访,随访终点为主动脉源性死亡,依据患者是否发生终点事件分为终点事件组(26例)和非终点事件组(104例)。分别采用独立样本t检验、非参数Mann-Whitney U检验、χ2检验或Fisher精确检验比较正态分布的连续变量、非正态分布的连续变量和分类变量的组间差异,并对随访结果作Cox回归分析及生存分析以确定独立危险因素。结果在基线CT资料中,主动脉最大管径(MAD)为(49.2±6.9)mm,最大血肿厚度(MTH)为11.0(8.5,13.2)mm。有溃疡样凸起(ULP)和壁内血池(IBP)征象的患者分别有56和30例,其中升主动脉ULP征象有36例,伴心包积液和胸腔积液的患者分别有51和50例。随访时间为1050(242,1949)d,随访期间有26例患者发生主动脉源性死亡。终点事件组患者与非终点事件组相比平均年龄和MAD更大(t=2.363、3.640,P=0.020、<0.001),有主动脉粥样硬化、ULP和心包积液的患者比例更高(χ2=5.275、6.596、9.325,P=0.022、0.010、0.002)。Cox回归多因素分析结果显示,主动脉粥样硬化[风险比(HR)=3.48,P=0.043]、ULP(HR=2.66,P=0.019)和心包积液(HR=2.49,P=0.030)是主动脉源性死亡的独立危险因素。结论对于保守治疗的A型IMH患者,主动脉粥样硬化、ULP及心包积液是后续发生主动脉源性死亡的独立预测因素,识别这些危险因素有助于进一步的危险分层和治疗决策。Objective To explore risk factors of death in type A intramural hematoma(IMH)patients with conservative therapy and provide important information for clinical risks stratification and decisions-making.Methods This retrospectively study enrolled 130 patients diagnosed with type A IMH in the first CT examination at Fuwai Hospital of Chinese Academy of Medical Sciences and only received conservative therapy between September 2009 and June 2018.Baseline clinical and CT characteristics were recorded.All patients enrolled were followed up.The endpoint was aortic disease-related death,patients were divided into endpoint group and non-endpoint group according to whether or not an endpoint event occurs.Difference between two groups of normally distributed continuous variables,non-normally distributed continuous variables and categorical variables were tested by independent sample t test,Mann-Whitney U test and chi-square test or Fisher′s exact test,respectively.Independent risk factors related to outcomes were assessed with Cox regression analysis and survival analysis.Results In baseline CT data,the mean value of the maximum aortic diameter(MAD)was(49.2±6.9)mm,and the median value of the maximum hematoma thickness(MTH)was 11.0(8.5,13.2)mm.There were 56 and 30 patients with ulcer-like projection(ULP)and intramural blood pool(IBP),respectively,which including 36 patients with ULP of ascending aorta,51 patients with pericardial effusion and 50 patients with pleural effusion.During a median follow-up time of 1050(242,1949)days,26 patients experienced aortic disease-related death.Compared with non-endpoint group patients,patients who experienced aortic disease-related death showed older age and larger MAD(t=2.363,3.640,P=0.020,<0.001),higher proportion of aortic atherosclerosis,ULP and pericardial effusion(χ2=5.275,6.596,9.325,P=0.022,0.010,0.002).In Cox regression multivariate analysis shows that aortic atherosclerosis[hazard ratio(HR)=3.48,P=0.043],ULP(HR=2.66,P=0.019)and pericardial effusion(HR=2.49,P=0.030)were indepe

关 键 词：主动脉 血肿 体层摄影术 X线计算机 危险因素 

分 类 号：R54[医药卫生—心血管疾病]