合并糖尿病的主动脉夹层患者临床特征及预后分析  

Clinical Features and Outcomes of Acute Aortic Dissection Patients Complicating With Diabetes

作　　者：陈宇飞 黄毕[1] 李晓飞[1] 王钊[1] 范思洋[1] 樊晓寒[1] CHEN Yufei;HUANG Bi;LI Xiaofei;WANG Zhao;FAN Siyang;FAN Xiaohan(State Key Laboratory of Cardiovascular Disease,Cardiac Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心律失常中心心血管病国家重点实验室,北京市100037

出　　处：《中国循环杂志》2021年第11期1107-1113,共7页Chinese Circulation Journal

摘　　要：目的:对比有无合并糖尿病的急性主动脉夹层(AAD)患者的临床特征,探讨糖尿病对AAD患者短期和中期预后的影响。方法:入选2008年1月至2010年12月就诊于中国医学科学院阜外医院急诊科,经CT确诊为AAD的患者。采集患者的基线资料,记录患者的治疗方案和住院期间预后,并对患者进行中期随访。结果:本研究共纳入994例AAD患者,其中Stanford A型AAD 520例,Stanford B型AAD 474例。Stanford A型AAD患者中有16例(3.1%)患者合并糖尿病,Stanford B型患者中有24例(5.1%)患者合并糖尿病。合并糖尿病的AAD患者平均年龄、合并高血压、冠心病和高脂血症的比例均高于未合并糖尿病的AAD患者(P<0.05)。合并和未合并糖尿病的AAD患者30 d死亡率分别为2.5%和8.2%,两者之间差异无统计学意义(P>0.05)。多因素Cox回归显示糖尿病不是影响AAD患者短期预后(HR=0.251,95%CI:0.027~2.372,P>0.05)或中期预后(HR=0.233,95%CI:0.030~1.819,P>0.05)的独立因素。结论:合并糖尿病的AAD患者的平均年龄较大,合并高血压、冠心病和高脂血症的比例高,但糖尿病不是AAD患者短期或中期预后的影响因素。Objectives:To explore the clinical characteristics and short and mid-term prognosis of acute aortic dissection(AAD)patients with or without diabetes.Methods:The patients diagnosed with AAD by computed tomographic(CT)in the emergency department of Fuwai Hospital from January 2008 to December 2010 were enrolled.We collected the clinical data,treatment strategy and in-hospital outcomes.The patients were followed up for mid-term prognosis.Results:A total of 994 patients with AAD were enrolled in this study,including 520 Stanford type A and 474 Stanford type B AAD patients.Diabetes was diagnosed in 16(3.1%)Stanford type A AAD patients and 24(5.1%)Stanford type B patients.The AAD patients complicating with diabetes had higher average age and prevalence of hypertension,coronary heart disease and hyperlipemia than those without diabetes(all P<0.05).The 30-day mortality rates of AAD patients with or without diabetes were 2.5%and 8.2%respectively(P>0.05).The multivariate Cox regression analysis showed that diabetes was not an independent factor affecting the short-term(HR=0.251,95%CI:0.027-2.372,P>0.05)and mid-term(HR=0.233,95%CI:0.030-1.819,P>0.05)prognosis among AAD patients.Conclusions:Patients with AAD and diabetes are older,have higher prevalence of hypertension,coronary heart disease and hyperlipemia than those without diabetes.However,diabetes is not an independent risk factor for the short and mid-term prognosis among AAD patients.

关 键 词：急性主动脉夹层 糖尿病 死亡率 预后 

分 类 号：R54[医药卫生—心血管疾病]