580例主动脉夹层患者临床特征及预后分析

目的 探讨主动脉夹层(aortic dissection,AD)患者的临床特征及预后相关影响因素.方法 收集580例确诊AD患者的临床资料,对一般情况、既往病史、症状与体征、辅助检查、诊断、治疗及住院期间生存情况等进行回顾性分析,采用Logistic单因素及多因素回归分析比较Stanford A型和B型患者年龄、性别、高血压史、收缩压水平、舒张压水平、D-二聚体(D-dimer)、白细胞(white blood cell,WBC)、心肌钙蛋白T(cardiac troponin T,cTnT)、氨基端前脑钠肽(N-terminal pro-brain natriuretic peptide,NT-proBNP)、纤维蛋白原(fibrinogen,FIB)以及是否手术等因素是否与AD患者近期预后相关.结果 580例AD患者中男性发病明显高于女性,男女比例约3.57:1.58.62％的AD患者有高血压病史.主动脉夹层的临床表现多样,以单纯胸痛、背痛及同时胸背痛为主要症状,部分患者可伴有腹痛或转移痛.Stanford A型患者胸膜反应、中重度主动脉反流、心包积液、异常心电图发生率以及主动脉根部直径、血D-二.聚体、WBC、cTnT和NT-proBNP水平均明显高于B型患者(P＜0.05),主动脉异常、无主动脉反流和正常心电图发生率均明显低于B型患者(P＜0.05).本组病例以非手术组病死率高于手术组(70％ vs.8.61％,P＜0.05),Stanford A型病死率高于Stanford B型(29.43％ vs.13.75％,P＜0.05).Stanford A型患者Logistic多因素分析提示D-二聚体(OR=1.23)、NT-proBNP(OR=1.006)和是否手术(OR=0.124)为A型患者独立预后因素;Stanford B型患者Logistic多因素分析提示D-二聚体(OR=1.801)、WBC(OR=1.59)和是否手术(OR=0.142)为B型患者独立预后因素.结论 主动脉夹层的临床表现复杂,D-二聚体、NT-proBNP和是否手术是影响A型患者住院期间预后的独立因素,D-二聚体、WBC和是否手术是影响B型患者住院期间预后的独立因素.

Analysis of clinical features and prognosis analysis of 580 cases with aortic dissection

Objective To explore the clinical features and prognosis of aortic dissection (AD).Methods The clinical data of 580 patients with AD collected including the general situation,medical history,symptoms and signs,adjunctive examination,diagnosis,treatment and hospitalization survival situation were analyzed retrospectively.A total of 11 factors includes age,gender,history of hypertension,systolic pressure,diastolic blood prcssurc,D-dimcr,cardiac troponin T (cTnT),N-terminal pro-brain natriuretic peptide (NT-proBNP),fibrinogen (FIB),and surgery were analyzed to find the difference in the prognosis of Stanford type A and type B patients by the analyses of univariate and multivariate Logistic regression.Results Among 580 cases with AD,male patients was significantly predominant over female,leading to the male/female ratio of 3.57:1.Up to 58.62％ of patients with AD had a history of hypertension.The symptoms and physical signs of the AD patients were varied,chest and back pain were main symptoms,and some patient had abdominal pain or wandering pain.Pleural reaction,moderate and severe aortic regurgitation,pericardial effusion,abnormal electrocardiogram occurrence rate and aortic root diameter,D-dimer,cTnT and NT-proBNP and WBC count in type A patients were significantly higher than those in type B patients (P ＜ 0.05),while the incidence of aortic abnormalities,non aortic regurgitation and normal ECG in type A patients were significantly lower than those in type B patients (P ＜ 0.05).The mortality in the non operation group was higher than that in operation group (70％ vs.8.61％,P ＜0.05),and the mortality of type A patients was higher than that in type B patients (29.43％ vs.13.75％,P ＜0.05).Logistic multivariate analysis of AD patients show that D-dimer (OR =1.23),NT-proBNP (OR =1.006) and surgery (OR =0.124) were independent prognostic factors for type A patients while D-dimer (OR =1.801),WBC (OR =1.59) and surgery (OR =0.142) were independent prognostic factors for type B patients.Conclusions The clinical features of AD were complex,and D-dimer,NT-proBNP and surgery were the independent prognostic factors in type A patients,while D-dimer,WBC and surgery were the independent prognostic factors in type B patients.