Stanford B型主动脉壁内血肿患者发生主动脉相关不良事件的临床特征及影像学分析

目的 评价Stanford B型壁内血肿（IMH）患者发生主动脉相关不良事件的临床特点和预后因素。 方法 回顾性分析2013年4月至2021年3月就诊于北部战区总医院的IMH患者共579例，根据纳入标准和排除标准，最终有372例IMH患者入选。根据是否发生主动脉相关不良事件分为事件组（n = 81）和对照组(n = 291)，观察两组患者的临床特征及确诊时的首次影像学特征。 结果 两组患者性别、吸烟史、高血压病史、糖尿病史、脑血管病史等差异均无统计学意义，事件组患者年龄显著小于对照组[（59 ± 11）岁VS（65 ± 10）岁，P<0.01]，对比两组患者临床特征和首次确诊的主动脉增强CT（CTA）参数，行logistic回归分析提示，年龄（OR = 0.943, 95%CI:0.913-0.974；P<0.01），CTA中测量的降主动脉最大直径(OR = 1.325, 95%CI:1.231-1.425；P<0.01)，壁内血肿并发溃疡样突起（OR = 3.975, 95%CI:1.744-9.060；P<0.01）是预测IMH患者发生主动脉相关不良事件的独立危险因素。 结论 单中心资料表明，对于Stanford B型IMH患者，首次确诊时年龄小，首次CTA中的降主动脉最大直径增大、并发溃疡样凸起可以预测主动脉相关不良事件发生。

Clinical features and imaging analysis of aortic adverse events in Stanford type B intramural aortic hematoma

AIM To evaluate the clinical characteristics and prognostic factors of aortic related adverse events in patients with Stanford type B intramural hematoma (IMH). METHODS A total of 579 patients with IMH admitted to the General Hospital of the Northern Theater Command from April 2013 to March 2021 were retrospectively analyzed and patients who did not meet the inclusion criteria and had incomplete clinical follow-up data were excluded. Finally, 372 patients with Stanford type B intramural haematoma were enrolled in this study. According to whether or not the patients had aortic related adverse events, the patients were divided into the event group and the control group, and the clinical characteristics and the first imaging characteristics at diagnosis of the two groups were observed. RESULTS Among the 372 patients, 81 patients (21.7%) who had aortic related adverse events were assigned to the event group and 291 patients who had no aortic related adverse events served as the control group. There were no significant differences in gender, smoking history, history of hypertension, history of diabetes and history of cerebrovascular disease between the two groups. The mean age of patients in the event group was younger than that in the control group [(59±11 years) vs. (65±10 years), P<0.001]. The logistic multivariate regression analysis was performed to compare the clinical characteristics and the parameters of the first diagnosed aortic enhancement CT (CTA) in the two groups. Age (OR = 0.943, 95%CI: 0.913-0.974, P<0.001), the maximum descending aorta diameter measured in CTA (OR = 1.325, 95%CI: 1.231-1.425, P<0.001) and intramural haematoma with ulcer-like projection (OR = 3.975, 95%CI: 1.744-9.060, P = 0.001) were independent risk factors for aortic related adverse events in patients with IMH. CONCLUSIONS Single-center data indicate that for Stanford type B IMH patients, younger age at first diagnosis, increased maximum descending aorta diameter in the first CTA and associated ulcer-like projection can predict the occurrence of aortic related adverse events.