急性主动脉夹层临床特征的分析

目的：了解当前国人急性主动脉夹层（AAD）的临床特征，以指导疾病诊断及治疗。方法收集2008年1月1日~2011年12月31日国内15家大型心脏中心经影像学检查确诊AAD患者1812例（其中Stanford A型726例，Stanford B型1086例）的临床资料。研究内容包括人口学特征、合并症、临床表现、诊断、治疗、预后及随访等情况，并比较Stanford A型与B型夹层患者之间临床特征的差别。结果患者平均年龄为（51.1±10.9）岁，男女比例约为3.44：1。Stanford B型AAD患者的平均年龄大于A型AAD患者[（53.3±10.1）vs.（47.5±11.2），P＜0.001]，Stanford A型AAD患者男性比例较B型更高（83.7%vs.73.3%，P＜0.001）。B型AAD患者中，86.8%患者合并高血压病，22.0%患者合并动脉粥样硬化，49.5%患者吸烟，均高于A型夹层患者（P＜0.05）。A型AAD患者中，32.5%患者合并马凡综合征，19.1%患者合并主动脉瓣二瓣化畸形，均明显高于B型AAD患者（P＜0.01）。A型AAD患者有疼痛表现占89.4%，其中前胸痛76.3%，迁移痛12.3%；B型AAD患者中背痛占73.8%，腹痛14.2%。76.3% AAD患者采用CT检查确定诊断。75.3% A型AAD患者实施了外科手术治疗，死亡率为15.9%；76.1%B型AAD患者实施了血管内介入治疗，术后发生内漏占7.8%，死亡率为0.6%。Cox住院死亡风险显示，合并高血压病发生AAD的风险度（HR）为2.80、合并马凡综合征HR为1.76。结论与Stanford B型AAD比较，A型AAD患者发病年龄较轻，且男性比例较高。B型AAD患者多合并高血压、动脉粥样硬化和吸烟，A型AAD患者多合并马凡综合征和主动脉瓣二瓣化畸形多见。疼痛是主要的临床表现，CT检查是最常用的确定诊断方法。

Clinical characteristics of acute aortic dissection

Objective To investigate the clinical characteristics of acute aortic dissection （AAD） in Chinese people for guiding diagnosis and treatment.Methods The clinical data were collected from 1812 patients with AAD diagnosed with imageological examinations [726 with Stanford type A AAD （group A） and 1086 with Stanford type B AAD （group B）] from 15 large heart centers from Jan. 1, 2008 to Dec. 31, 2011. The study content included demographic characteristics, complications, clinical manifestations, diagnosis, treatment, prognosis and follow-up. The difference in clinical characteristics was compared between two groups.Results The average age was （51.1± 10.9）, and ratio of male to female was 3.44 to 1. The average age was higher in group B than that in group A [（53.3 ±10.1）vs. （47.5±11.2）,P〈0.001]. The percentage of male patients was higher in group A than that in group B （83.7%vs. 73.3%,P〈0.001）. In group B, 86.8% patients had hypertension, 22.0% had atherosclerosis and 49.5%had smoking history, and all of them were higher than those in group A （P〈0.05）. In group A, 32.5% had Marfan syndrome and 19.1% patients had bicuspid aortic valve, and all of them were significantly higher than those in group B （P〈0.01）. In group A, 89.4% patients had pain symptoms, among them 76.3% had anterior chest pain and 12.3%had migration pain. In group B, 73.8% patients had back pain and 14.2% had abdominal pain. The patients with CT scan for confirming diagnosis accounted for 76.3%. In group A, 75.3% patients had surgical therapies and mortality was 15.9%. In group B, 76.1% patients had intravascular intervention, 7.8% had postoperative endoleak and mortality was 0.6%. Cox hospitalization risk analysis showed that the hazard rate （HR） of complicating hypertension was 2.80, and HR of complicating Marfan syndrome was 1.76.Conclusion Compared with group B, the age of AAD attack is lower and male percentage is higher in group A. The most of patients in group B have complicating hypertension and atherosclerosis and smoking history, and most of those in group A have complicating Marfan syndrome and bicuspid aortic valve. Pain is main clinical manifestation and CT scan is the most common method for confirming diagnosis.