急性A型主动脉夹层累及肾动脉的超声特征及其与肾功能关系的回顾性队列研究  

Ultrasonographic characteristics of renal artery involvement in acute Stanford type A aortic dissection and its relationship with renal function:A retrospective cohort study

作　　者：卿秋杉 韦馨[1] 郑红[1] 王征 伍长学 陈沛锐 QING Qiushan;WEI Xin;ZHENG Hong;WANG Zheng;WU Changxue;CHEN Peirui(Department of Ultrasound Diagnostics,Deyang People's Hospital,Deyang,618000,Sichuan,P.R.China)

机构地区：[1]德阳市人民医院超声诊断科,四川德阳618000

出　　处：《中国胸心血管外科临床杂志》2025年第4期527-533,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：德阳市人民医院院内孵化项目(FH202307);德阳市科技局项目(2022SC2138)。

摘　　要：目的探讨急性A型主动脉夹层(acute Stanford type A aortic dissection,ATAAD)累及肾动脉的超声特征及与肾功能的关系。方法选择2013年2月—2023年5月德阳市人民医院收治ATAAD患者作为研究对象。根据夹层是否累及肾动脉,将患者分为肾动脉累及组和肾动脉未累及组,比较两组患者的一般资料以及超声特征。通过logistic回归分析并构建校正模型,分析ATAAD患者超声特征与肾功能累及的关系;采用受试者工作特征(receiver operating characteristic,ROC)曲线评估超声特征对ATAAD患者累及肾动脉的预测价值;另根据血清尿素氮(blood urea nitrogen,BUN)和肌酐(serum creatinine,Scr)水平,将肾动脉累及组患者分为肾功能正常组和肾功能异常组,比较两组患者的临床资料,采用log-binomial模型分析肾功能与累及肾动脉的超声特征风险效应;采用Pearson相关分析法分析累及肾动脉的超声特征与肾功能指标的相关性。结果纳入患者163例,其中男106例、女57例,年龄20~85(50.06±10.46)岁。肾动脉累及组和未累及组患者性别、Scr、BUN差异均具有统计学意义(P<0.001);与肾动脉未累及组患者相比,肾动脉累及组升主动脉内径、主动脉增宽和肾灌注差患者比例更大(P<0.05);logistic回归分析结果显示,升主动脉内径、升主动脉增宽、肾灌注差是累及肾动脉的独立影响因素(P<0.05);超声特征对ATAAD患者累及肾动脉的预测效能良好,且三者联合预测累及肾动脉,预测效能更高。与肾功能正常组患者相比,肾功能异常组患者BUN、Scr水平更高,升主动脉内径、升主动脉增宽和肾灌注差患者比例更大(P<0.05);log-binomial模型分析结果显示,升主动脉内径、升主动脉增宽、肾灌注差风险比显著性调整前后均具有统计学意义(P<0.05);Pearson相关分析结果显示,升主动脉内径、升主动脉增宽、肾灌注差与肾功能指标密切相关(P<0.05)。结论ATAAD累及肾动脉的超声特Objective To investigate the ultrasonographic characteristics of acute Stanford type A aortic dissection(ATAAD)involving the renal arteries and their relationship with renal function.Methods Patients with ATAAD admitted to Deyang People's Hospital from February 2013 to May 2023 were selected for the study.Based on whether the renal arteries were involved in the dissection,the patients were divided into two groups:a renal artery involvement group and a renal artery non-involvement group.General data and ultrasound characteristics of the two groups were compared.Logistic regression analysis and model correction were performed to analyze the relationship between ultrasound characteristics and renal function involvement in ATAAD patients.Receiver operating characteristic(ROC)curves were used to evaluate the predictive value of ultrasound characteristics for renal artery involvement in ATAAD patients.Additionally,patients in the renal artery involvement group were divided into normal renal function and abnormal renal function subgroups based on serum blood urea nitrogen(BUN)and serum creatinine(Scr)levels.Clinical data of the two subgroups were compared,and a log-binomial model was used to analyze the risk effects of ultrasound characteristics for abnormal renal function.Pearson correlation analysis was performed to assess the correlation between ultrasound characteristics of renal artery involvement and renal function indicators.Results A total of 163 patients were included,consisting of 106 males and 57 females,with a mean age of(50.06±10.46)years(ranging from 20 to 85 years).Significant differences in gender,Scr,and BUN were observed between the renal artery involvement group and the renal artery non-involvement group(P<0.001).Compared to the renal artery non-involvement group,the renal artery involvement group had an increased ascending aorta diameter,a greater proportion of ascending aortic dilation and poor renal perfusion(P<0.05).Logistic regression analysis indicated that ascending aorta diameter,ascending ao

关 键 词：急性A型主动脉夹层 肾动脉受累 CT血管成像术 肾功能 

分 类 号：R543.1[医药卫生—心血管疾病]