非感染性主动脉炎患者的单中心回顾性分析

 目的 总结非感染性主动脉炎患者的临床特点。方法 回顾性分析2010年1月至2017年12月于复旦大学附属中山医院心脏外科和（或）风湿免疫科住院诊治的124例非感染性主动脉炎患者术前的一般资料、实验室和辅助检查以及手术后转归等。结果 124例患者中有大动脉炎45例（36.3%）、孤立性主动脉炎40例（32.3%）、白塞病37例（29.8%）、巨细胞动脉炎2例（1.6%），以中重度主动脉瓣关闭不全最常见（82例，66.1%）。大动脉炎组女性更多见（3.5：1），孤立性主动脉炎组发病年龄（53.5±9.4）岁]及诊断年龄（55.0±9.3）岁]更大（P<0.05）。97例（78.2%）接受手术治疗，其中1次手术69例、≥ 2次手术28例，有44例（45.4%）接受术前糖皮质激素和/或免疫抑制剂治疗。初次手术以主动脉瓣置换术（40.2%）、Bentall术（23.7%）、冠脉搭桥术（11.3%）最常见，术后收缩压得到显著改善（119.2±38.1） mmHg vs.（108.9±37.9） mmHg，P<0.001]。≥ 2次手术以主动脉瓣瓣周漏（19例，67.9%）为主要原因，其中白塞病（13例，68.4%）多见，仅7例（36.8%）患者在术前接受了糖皮质激素和/或免疫抑制剂治疗。与97例手术患者相比，27例未做手术的患者中，合并糖皮质激素和（或）免疫抑制剂治疗（63.0%）者比例更高、诊断年龄（41.6±16.4）岁]更年轻、女性（74.1%）更多见，其中17例（63.0%）患者通过糖皮质激素和（或）免疫抑制剂治疗后延期手术。结论 非感染性主动脉炎主要见于大动脉炎、孤立性主动脉炎、白塞病等原发性系统性血管炎患者，以主动脉瓣关闭不全最常见。内科治疗有助于控制炎症、延缓手术，手术治疗有助于改善血压。未经过内科治疗的白塞病患者更易出现术后瓣周漏。

Single-center retrospective analysis of patients with non-infectious aortitis

Objective To summarize the clinical characteristics of patients with non-infectious aortitis. Methods A retrospective analysis was made among 124 patients with non-infectious aortitis who were hospitalized in the Department of Cardiac Surgery and/or Rheumatology in Zhongshan Hospital Affiliated to Fudan University,from Jan.,2010 to Dec.,2017.Data were collected and analyzed,including preoperative general information,laboratory and radiologic examinations,and the clinical and surgical outcomes. Results Among the 124 patients,there were 45 patients of Takayasu arteritis (36.3%),40 patients of isolated aortitis (32.3%),37 patients of Behcet's disease (29.8%) and 2 patients of giant cell arteritis (1.6%).Moderate to severe aortic valve insufficiency was the most common (82 patients,66.1%).Takayasu arteritis group was female dominant (3.5:1),while the onset age(53.5+9.4) years] and diagnosis age(55.0+9.3) years] in isolated aortitis group were much older (P<0.05).Ninety-seven patients (78.2%) received surgical treatment,of which 69 received primary operations,28 received secondary operations.Forty-four cases (45.4%) received preoperative treatments of glucocorticoid and/or immunosuppressive agents.Aortic valve replacement (40.2%),Bentall's operation (23.7%) and coronary artery bypass grafting (11.3%) were the most common types of primary operations,resulting in significant decrease in systolic blood pressure(119.2±38.1) mmHg vs.(108.9±37.9) mmHg,P<0.001].Perivalvular aortic leakage (19 patients,67.9%) was the main cause of secondary operations,of which Behcet's disease (13 patients,68.4%) was common,and only 7 patients (36.8%) received glucocorticoid and/or immunosuppressive therapy prior to operations.Compared with 97 patients with surgery,the proportion of patients treated with glucocorticoids and/or immunosuppressive agents (63.0%) in 27 non-surgery patients was higher,the age of diagnosis (41.6 + 16.4 years) was younger,and women (74.1%) were more common.Of them,17 patients (63.0%) postponed surgery after treatment with glucocorticoids and/or immunosuppressive agents. Conclusions Non-infectious aortitis was mainly seen in patients with primary systemic vasculitis such as Takayasu arteritis,isolated aortitis and Behcet's disease,with the most common lesion of aortic valve insufficiency.Medical treatment could help control inflammation and delay operation,and surgical treatment could help improve blood pressure.Patients with Behcet's disease without medical treatment would be more likely to suffer from perivalvular leakage after operation.