B型主动脉夹层主动脉形态改变危险因素的研究  

Risk Factors of Aortic Morphological Change in Patients With Type B Aortic Dissection

作　　者：李嘉琦 张静怡 王家平[3] LI Jiaqi;ZHANG Jingyi;WANG Jiaping(Department of Pulmonary and Critical Care Medicine,The First People's Hospital of Yunnan Province,The Affiliated Hospital of Kunming University of Science and Technology,Kunming 650032,China;Department of Gastroenterology,The First People's Hospital of Kunming,Kunming 650000,China;Department of Radiology,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)

机构地区：[1]云南省第一人民医院、昆明理工大学附属医院呼吸与危重症医学科,昆明650032 [2]昆明市第一人民医院消化内科,昆明650000 [3]昆明医科大学第二附属医院放射科,昆明650101

出　　处：《中国循环杂志》2023年第7期742-749,共8页Chinese Circulation Journal

基　　金：云南省呼吸系统疾病临床医学研究中心项目(ZX2019-01-03);云南省中青年学术和技术带头人后备人才项目(2017HB037)。

摘　　要：目的:分析与B型主动脉夹层(TBAD)相关的主动脉形态改变危险因素。方法:回顾性分析2017年1月至2021年12月期间于昆明医科大学第二附属医院接受胸腹主动脉CT血管造影(CTA)检查的280例住院患者临床资料,根据CTA诊断将其分为TBAD组(n=105)和无主动脉疾病的对照组(n=175)。进行倾向得分匹配,比较两组患者一般资料及主动脉形态学指标,分析与TBAD相关的主动脉形态改变危险因素。结果:匹配后,每组99例患者,两组患者基线特征差异均无统计学意义(P均>0.05)。TBAD组头臂干(BCT)、左颈总动脉(LCCA)和左锁骨下动脉(LSA)三分支根部直径均大于对照组(P均<0.001),但在开口10 mm处直径两组差异均无统计学意义(P均>0.05);TBAD组LSA与主动脉弓长轴夹角大于对照组,LSA与主动脉弓短轴夹角小于对照组(P均<0.01);TBAD组主动脉弓宽度及高度均较对照组增大(P均<0.001);TBAD组升主动脉曲率小于对照组,主动脉弓曲率半径大于对照组(P均<0.001);TBAD组主动脉弓局部扭转度及主动脉全程扭转度均大于对照组(P均<0.001);TBAD组主动脉窦管交界处、升主动脉中点处、BCT近端、LCCA近端、LSA近端各点处直径,升主动脉和主动脉弓长度均明显大于对照组(P均<0.001)。多因素Logistic回归分析显示,LSA根部直径增大(OR=9.244,95%CI:1.386~61.638,P=0.022)、主动脉弓宽度增大(OR=1.604,95%CI:1.110~2.320,P=0.012)、升主动脉曲率减小(OR=0.680,95%CI:0.474~0.976,P=0.036)、主动脉弓曲率半径增大(OR=0.470,95%CI:0.234~0.942,P=0.033)、主动脉弓局部扭转度增大(OR=1.534,95%CI:1.110~2.120,P=0.010)与TBAD的发生独立相关。结论:TBAD患者与无主动脉疾病的对照人群主动脉形态存在一定差异,其中LSA根部直径、主动脉弓宽度、升主动脉曲率、主动脉弓曲率半径以及主动脉弓局部扭转度与TBAD发生相关。Objectives:To analyze the risk factors of aortic morphological changes associated with type B aortic dissection(TBAD).Methods:Clinical data of 280 inpatients who received CT angiography of thoracic and abdominal aorta in the Second Affiliated Hospital of Kunming Medical University from January 2017 to December 2021 were retrospectively analyzed.According to diagnosis,they were divided into TBAD group(n=105)and control group without aortic disease(n=175).General data and aortic morphological indexes were compared between the two groups before and after propensity score matching.Risk factors of aortic morphological changes related to TBAD were determined.Results:After propensity score matching,there were 99 patients in each group,and there was no statistical significance in baseline clinical characteristics between the two groups(all P>0.05).The root diameter of the branchiocephalic trunk(BCT),left common carotid artery(LCCA)and left subclavian artery(LSA)was larger in TBAD group than in control group(all P<0.001).The diameter round 10 mm to opening was similar(all P>0.05).The angle between LSA and major axis of aortic arch was greater,and the angle between LSA and minor axis of aortic arch was smaller in TBAD group than in control group(both P<0.01).Aortic arch width and height were increased in TBAD group compared with control group(all P<0.001).The curvature of ascending aorta was lower,and the curvature radius of aortic arch was higher in TBAD group than in control group(both P<0.001).The local torsion of aortic arch and the total torsion of aorta were greater in TBAD group than in control group(all P<0.001).The diameters at the junction of aortic sinus canal,the midpoint of ascending aorta,the proximal point of BCT,the proximal point of LCCA and the proximal point of LSA,and the length of ascending aorta and aortic arch were significantly greater in TBAD group than in control group(all P<0.001).Multifactorial logistic analysis illustrated that increased diameter at the opening of the LSA(OR=9.244,95%CI:1.386-6

关 键 词：B型主动脉夹层 主动脉形态学 解剖 危险因素 

分 类 号：R54[医药卫生—心血管疾病]