B型主动脉夹层患者的临床特点及预后随访  

Clinical Characteristics and Prognosis of Type B Aortic Dissection

作　　者：于易通 任心爽 尹卫华[1] 安云强 李海彬 马亚南[1] 陈远 吕滨[1] YU Yitong;REN Xinshuang;YIN Weihua;AN Yunqiang;LI Haibin;MA Yanan;CHEN Yuan;LYU Bin(Radiology Department,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放射影像科,北京市100037 [2]首都医科大学附属北京朝阳医院心脏中心心外科

出　　处：《中国循环杂志》2022年第11期1130-1137,共8页Chinese Circulation Journal

基　　金：国家自然科学基金青年基金(82000444)。

摘　　要：目的:了解B型主动脉夹层患者的临床特点、预后及长期变化趋势。方法:连续纳入中国医学科学院阜外医院2010~2019年经CT确诊为B型主动脉夹层的933例患者,回顾性分析其临床特点及预后,并总结十年期间的变化趋势。结果:在933例B型主动脉夹层患者中,男性762例(81.7%),平均年龄(50.78±11.81)岁,平均体重指数(26.23±3.95)kg/m2,788例(84.5%)有高血压;男性患者中高血压(86.6%vs.74.9%)、吸烟(56.8%vs.5.3%)较女性患者更常见,而马凡综合征(0.5%vs.4.1%)较少见(P均<0.01)。673例(72.1%)患者就诊时处于急性期,疼痛是最常见的症状(879例,94.2%)。CT显示,146例(15.6%)患者主动脉弓部受累,507例(54.3%)假腔血栓化,253例(27.1%)肾灌注缺损,心包、胸腔积血及纵隔、腹腔血肿等主动脉破裂征象占比均<2.0%;腹腔干、肠系膜上动脉及肾动脉受累比例均<10.0%;男性患者腹腔干、肠系膜上动脉、髂动脉受累比例均明显高于女性患者(分别为:6.8%vs.1.8%;8.7%vs.3.5%;62.6%vs.50.9%;P均<0.05)。不同疾病分期B型主动脉夹层患者的治疗方式均以腔内介入治疗为主。2010~2019年十年期间,有高血压病史及接受药物保守治疗的B型主动脉夹层患者呈增多趋势(P均<0.01)。急性期接受药物保守治疗的B型主动脉夹层患者死亡率明显高于接受手术治疗的患者(12.8%vs.2.5%,P=0.003)。结论:与女性患者相比,男性B型主动脉夹层患者中高血压、吸烟更常见,夹层累及范围更广。2010~2019年十年期间,有高血压病史及接受药物保守治疗的B型主动脉夹层患者呈增多趋势。与药物保守治疗相比,B型主动脉夹层急性期手术治疗的效果更好。Objectives:To explore the clinical characteristics and prognosis and the trend change in the past decade of patients with type B aortic dissection.Methods:This retrospective analysis included patients with the CT confirmed diagnosis of type B aortic dissection in our hospital from 2010 to 2019.The clinical manifestation and prognosis of the patients were analyzed,and their changes during the 10 years were summarized.Results:Among the consecutive 933 patients with type B aortic dissection,762(81.7%)were male,the mean age was(50.78±11.81)years,body mass index was(26.23±3.95)kg/m2,and prevalence of hypertension was 788(84.5%).Hypertension(86.6%vs.74.9%)and smoking(56.8%vs.5.3%)were more common and Marfan syndrome(0.5%vs.4.1%)was less common in male patients than in female patients(all P<0.01).673(72.1%)of patients were hospitalized in the acute phase,and pain was the most common symptom(94.2%).CT showed that arch was involved in 146 patients(15.6%),false lumen thrombosis formed in 507 patients(54.3%),and renal malperfusion occurred in 253 patients(27.1%).The proportions of signs of aortic rupture,including hemopericardium,hemothorax,mediastinal hematoma and abdominal hematoma were all less than 2.0%.The proportions of involvement of celiac trunk,superior mesenteric artery and renal artery were all less than 10.0%,and the involvement of celiac trunk,superior mesenteric artery and iliac artery were more common in male patients than in female patients(6.8%vs.1.8%;8.7%vs.3.5%;62.6%vs.50.9%,respectively,all P<0.05).Endovascular treatment was the main treatment option regardless of disease stage.During the 10-year period,the number of patients with a history of hypertension and patients treated with medication only increased significantly(P<0.01).The mortality rate of patients treated with medication only was significantly higher than that of patients treated with surgery in the acute phase(12.8%vs.2.5%,P=0.003).Conclusions:Hypertension and smoking were more common in male patients with type B aortic dissection,and rate

关 键 词：主动脉夹层 临床特点 体层摄影术 X线计算机 预后 队列研究 

分 类 号：R54[医药卫生—心血管疾病]