主动脉夹层患者临床特征及预后分析研究

目的探讨主动脉夹层患者的临床特征及预后相关影响因素。方法收集阜外医院2004年6月～2007年12月内科住院治疗的199例主动脉夹层患者临床资料，并对所有患者进行随访，按年龄、性别、Stanford分型分析临床特征，应用单因素及logistic多元回归分析主动脉夹层预后的影响因子。结果年轻患者（〈60岁）左室舒张期内径（52．3．4±6．6VS49．2±6．6，P〈0.01）、白细胞计数（11．08±5，18VS8．96±4．72，P〈0．01）显著高于老年患者（≥60岁）。StanfordB型患者的舒张乐水平（80．2±17．0VS69．5±15．2．P〈0．01）和支架治疗率（24．8％VS0％，P〈0．01）显著高于A型患者；A型患者心率（84．0±15．4、’s75．3±15．2．P〈0．01），血白细胞计数（11．77±4．90VS9．85±5．14，P〈0．05），高敏CRP值（12．5±4．90VS9．64±5．35，P〈0．01）和外科手术治疗率（17．7％VS4．4％，P〈0．01）显著高于B型患者。男性患者BMI（25．8±3．16VS23．4±34．33，P〈0．01）、舒张压水平（78．1±17．4VS70．1±13．9，P〈0．05）及左室舒张期内径（52．1±6．23VS47．9±8．45，P〈0．01）显著高于女性，女性患者心电图异常改变显著高于男性（63．3％VS39．5％，P〈0．05）。分型、性别与预后显著相关。Logistic多元同归调整多个危险因素后发现，女性患者死亡危险性显著增加（OR4．387，95％CI1．47～13．03，P=0．008），而舒张压升高对预后具有保护作用（OR0．937，95％C10．901～0．975，P：0．001）。结论主动脉夹层患者年龄、分型、性别不同，其临床特征有不同程度的差异，年龄、分型、性别及舒张压水平是预后相关因素，其中女性、舒张压水平是影响预后的独立因素。

Clinical features and prognosis of patients with aortic dissection

Objectives To explore the clinical features and prognosis of aortic dissection. Methods Retrospective analyses were conducted on clinical data of 199 patients with aortic dissection in Fuwai Hospital. The data were analysed according to Stanford type ,gender,age. The prognosis of aortic dissection was analysed by by logistic multivariate regression analysis. Results The diameter of LV （ 52.3 ± 6.6 vs 49.2 ± 6.6, P 〈 0.01 ） and the number of white blood cell（ 11.08 ± 5.18 vs 8.96 ± 4.72, P 〈 0. 01 ） were significantly increased in younger than in older patients. The DBP lever（80.2 ± 17.0 vs 69.5 ± 15.2,P 〈0.01 ） and thefrequency of stent treatment were higher in Type B than type A （24.8% vs 0% , P 〈0.01 ）. Type A patients had higher heart rate （ 84.0 ± 15.4 vs 75.3 ± 15.2, P 〈 0.01 ） , white blood cell （ 11.77 ± 4.90 vs 9.85 ± 5.14, P 〈 0.05 ）, hsCRP level （ 12.5 ± 4.90 vs 9.64 ± 5.35, P 〈 0. 01 ） and frequency of surgical operations （ 17.7% vs 4.4%, P 〈 0.01 ）. Man had higher BMI （25.8 ± 3.16 VS 23.4 ± 34.33, P 〈 0.01 ）, DBP lever （78.1 ± 17.4 VS 70.1 ± 13.9,P 〈0.05）, and LV（52.1 ±6.23 vs 47.9 ±8.45,P 〈0.01）than women. Women had more common ECG change than did man （63.3% vs 39.5% ,P 〈0.05）. After adjustment for conventional risk factors by logistic regression analysis, the risk of aortic dissection was significantly increased in women （OR 4. 387, 95% CI 1.47 to 13.03, P =0. 008） , and negatively assoeiated with diastolic blood pressure levels （ OR0. 937, 95% CI 0.90 to 0.97, P =0. 001 ）. Conclusions The clinic characters differed according to type and gender. The prognosis of aortic dissection was significantly associated with type, gender. Women and diastolic blood pressure level predicted independently the prognosis of aorticdissection.